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Individuals with disorders of consciousness, and those with locked-in syndrome (LIS), have significantly impaired ability to communicate by conventional means. Although the most severely affected patients – those in coma and vegetative state (VS) – are wholly unaware of their surroundings, people in a minimally conscious state (MCS) may be, and those with LIS are, aware of their situation, and it is known that some of them wish to die. Their physical disabilities make it impossible for them to end their own lives, so they have to rely on others’ willingness to comply with their requests to be allowed to die. English judges, although expressing profound sympathy for individuals in MCS or with LIS in such circumstances, have declined to permit their assisted deaths, holding that this would breach the Suicide Act 1961. This paper reviews some significant recent advances in neuroimaging techniques that may enable some individuals who have been diagnosed as being in MCS or VS to give deliberate positive or negative answers to simple questions. This paper argues that, wherever possible, the wishes of those with who are able to communicate only via neuroimaging should be sought, should be respected and, wherever practicable, should be acted upon. To do otherwise is to infringe the last vestige of autonomy of people who have already lost their dignity, their independence and, in some cases, their desire to live.

The ethical imperative of ascertaining and respecting the wishes of the minimally conscious patient facing a life-or-death decision