When Does Consciousness Matter? Lessons From the Minimally Conscious State

Patients in a minimally conscious state (MCS) fall into an importantly different diagnostic category than patients in the more familiar vegetative states (VS). Not only are MCS patients conscious in some sense, but they have a higher chance for recovery than patients in a VS. Because of these differences, we ostensibly have reason to provide MCS patients with care that goes beyond the care we provide to patients with some VS patients. But how do we justify this differential treatment? In this article, I argue we can't justify it solely by looking to MCS patients' actual levels of consciousness. We must rather look beyond MCS patients' actual levels of consciousness to the ways in which these patients are potentially conscious. More specifically, I argue that certain sensible and well-regarded policy recommendations cannot be justified by looking solely to patients' actual levels of consciousness, but that they can be justified by looking to patients' potential for consciousness. Insofar then as we have prima facie reason to follow the recommendations, we also have prima facie reason to view the potential for consciousness as morally salient. If that is true, however, several important implications follow: First, I suggest that if the potential for consciousness is morally salient, this translates into actual and pressing obligations to patients with disorders of consciousness generally. Second, if the potential for consciousness is morally salient, this has implications that go beyond our obligations to patients with disorders of consciousness. Indeed, if the potential for consciousness is morally salient, this adds an important layer of complexity to the normative landscape, a layer we may not have sufficiently noticed before.