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With advances in medical technology new prognostic tools become available to distinguish states of consciousness in unresponsive patients. Born from a desire to enhance the treatment and rehabilitation of such patients, these advances, however, hold ethical implications for what constitutes personhood.
The Borderlands of Living project traces uncertainties of prognostics of unresponsive patients with serious brain injury between scientific and clinical reasoning, as a study of knowledge relationality through an interdisciplinary inquiry taking its outset in anthropology, medical humanities and philosophy.
The project empirically studies the high-stake relationships of clinic and research, using functional magnetic resonance imaging (fMRI) method, electroencephalography (EEG) and other measures in efforts to develop prognostic tools for the unresponsive patients with uncertain consciousness. Examining these intersections of reasoning between clinic and research we learn about how they come to affect our understanding of responsiveness, consciousness and personhood.
Findings from the project will inform conversations on being human and add insights into how uncertainties of potential and personhood are negotiated in search of unambiguous signs of consciousness. It hereby carves out new trails in the conversations about the ethics of medical technologies and treatment in the borderlands of living, while critically examining the relationality of knowledge and methodological innovation.
The project collaborates with researchers and clinicians at the Radiology Department, Diagnostic Centre, University Research Clinic for Innovative Patient Pathways and the Neuro Intensive Step-down Unit, both at Silkeborg Regional Hospital, and researchers from the Center of Functionally Integrative Neuroscience (CFIN), Aarhus University.
The Borderlands of Living project is funded by The Carlsberg Foundation (2019-2021) through a Distinguished Fellowship awarded to Associate Professor Mette Terp Høybye, who is the principal investigator.
Uncertainty is a basic condition of medicine - in research, in the clinic and in the inter-section between the two domains. Prognostics is in its very nature an attempt to address and manage the uncertainty of the future. New technologies are continuously developed in order to make prognostics more precise and hence make the future more predictable. However, such technologies may not always serve to decrease uncertainty, but rather en-hance or introduce new uncertainties, and thereby open other futures than those imagined. Our study follows an interdisciplinary Danish research group currently seeking to advance methods of neuroimaging in prognostics for unresponsive patients with uncertain cons-ciousness due to anoxic brain injury after an out-of-hospital cardiac arrest. Applying an interdisciplinary approach combining ethnographic methods and philosophical analysis we trace the experience of uncertainty in this context of tool development at the intersection of scientific and clinical reasoning around disorders of consciousness. Specifically, we employ and develop the three-dimensional framework of uncertainty developed by Han, Klein and Arora (2011). We identify salient uncertainties from the perspective of the researchers and show how these lead to different uncertainties experienced by the clinicians. Additionally, we show that while ambiguity may be the source of different kinds of uncertainty, the con-text determines the nature of the source. Our investigation has a descriptive and theoretical focus, however, uncovering these details may serve as a basis for normative discussions of strategies for uncertainty management, as well as evidence evaluation in research and the clinic in the future.
