New Imaging Technologies at the End of Life: Promises and Ethical Challenges

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Andrea Vicini, S.J., M.D.
Boston College

Date:听March 30, 2011

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Abstract

Recent studies with functional Magnetic Resonance Imaging (fMRI) suggest that we might detect consciousness in vegetative patients with a minimally conscious state. Theologically, these developments invite us to re-think consciousness, identity, and care by focusing on relationality.

Speaker Bio

Andrea Vicini, S.J., M.D.

Andrea Vicini, S.J., M.D.,听is an Associate Professor of Moral Theology and Bioethics at the Faculty of Theology of Southern Italy: S. Luigi (Naples, Italy). He is currently Visiting Assistant Professor and was formerly Gasson Chair (2009-2010) at Boston College. A practicing pediatrician, he received his Medical Degree and specialization in pediatrics from the University of Bologna (Bologna, Italy), a Bachelors in Theology from Centre Sevres (Paris, France), a Licentiate in Sacred Theology from the Weston Jesuit School of Theology, a Ph.D. in Theological Ethics from Boston College, and a second doctorate in Sacred Theology at the Faculty of Theology of Southern Italy. He has taught in Italy, Albania, Mexico, Chad, France, and in the United States. A lecturer and member of important associations of moral theologians and bioethicists (in Italy, Europe and the United States), his research interests include: fundamental moral theology, biotechnologies, reproductive technologies, end of life issues, medical ethics, genetics, and environmental issues.听

Event Photos

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Andrea Vicini, SJ, M.D. spoke at a lunch colloquium presentation about the Promises and Ethical Challenges of New Imaging Technologies for End of Life Care on March 30, 2011 at the Boisi Center.

Boisi event
Boisi event

Photos by Boston College MTS Photography

Event Recap

Each year two million Americans suffer some form of traumatic brain injury (TBI); nearly 375,000 of these require hospitalization, 60,000 die and another 2,000 are left in a permanent unconscious state. To shed light on the ethics of this public health issue, the Boisi Center invited Andrea Vicini, S.J., a medical doctor (pediatrician) and theological ethicist, to discuss his work in the field. Currently a visiting professor at 情色空间, this summer he will leave his post at the Pontifical Faculty of Theology of Southern Italy to become an associate professor of Christian ethics at the 情色空间 School of Theology and Ministry.

Fr. Vicini鈥檚 work in bioethics involves a new imaging technology, functional magnetic resonance imaging (fMRI), which attempts to differentiate between different states of consciousness by measuring blood flow in the brain. Among the goals of fMRI research is to evaluate the likelihood of recovery from TBIs, but the present state of knowledge and technology leads to misdiagnosis rates of 40% or more. As medical research improves fMRI usefulness in this area, Fr. Vicini said, ethicists must address issues concerning the well-being and desires of the patient, the wishes of the family and the uncertainty involved in assessing consciousness.

Long-term brain injuries can place incredible stress on patients鈥 families and loved ones, not least because of the uncertainty and difficulty in assessing levels of consciousness. Fr. Vicini argued that end-of-life care should therefore be evaluated from three perspectives: consciousness, relational identity, and care. In evaluating a TBI patient鈥檚 state of consciousness (coma, vegetative state, minimally conscious state, or 鈥渓ocked-in syndrome鈥) and the likelihood of recovery, fMRI testing will eventually be extremely helpful. Relational identity involves considering the needs of a patient and their family and crafting a care plan well suited to the needs of both. Finally, the concept of care addresses not only strictly medical care but also holistic care that can take place outside the hospital setting.

In the lively Q & A session that followed, participants raised concerns about the prohibitive cost of this diagnostic tool for a majority of patients. Many in the audience empathized with the difficulty of making end-of-life care decisions and all agreed that these situations bring a certain humility to the practice of medicine, sometimes thought to have all the answers in the modern age.

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Further Reading

Books

Bauby, J.D.,听,听New York: A.A. Knopf, 1997.

Taylor, Jill Bolte,听, Penguin Group, June 2008.

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Hotz, Robert Lee,听听Wall Street Journal, 13 April 2011.

Jennings, B.,听听Hastings Center Report听36, No.2 (2006): 29-37.

Martone, M.,听听Hastings Center Report听31, No.2 (2001): 36-41.

Martone, M.,听听Annual of the Society of Christian Ethics听20, (2000): 309-327.

Martone, M.,听, CreateSpace, 2011.

Martone, M.,听听Journal of the Society of Christian Ethics听26, No.2 (2006): 201-217.

Monti, M.M., A. Vanhaudenhuyse, M.R. Coleman, M. Boly, J.D. Pickard, L. Tshibanda, A.M. Owen, and S. Laureys,听听New England Journal of Medicine听330, No.21 (1994): 1499-1508.

Clark, Meghan,听, Catholic Moral Theology, March 28, 2011.

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Traumatic Brain Injury has been labeled the "signature injury" of the wars in Afghanistan and Iraq. In a recent 3 part article,听Barbara Mannino听explores the science, personal, and policy aspects of this injury ("," March 09, 2011,听FOXBusiness).