Disorders of consciousness (DOCs) vary in the extent of their impairment of people’s decision-making capacities. Historical definitions of DOCs reveal the partial consciousness present in minimally conscious state (MCS) and absent in coma and vegetative state. This finding justifies involving MCS patients in their own medical decisions to the extent that their specific, momentary cognitive capacity condones: an effort that advanced neurotechnologies and therapies have the potential to uphold. Involving MCS patients in their medical decisions mitigates ethical concerns associated with the principles of substituted judgment and the best interest standard in the current surrogate decision-making framework used for medical decision-making for the minimally conscious. Based on the likelihood of ongoing neurotechnological and therapeutic advancements, I argue on behalf of adapting a new decision-making framework for medical decisions for the minimally conscious. This hybrid framework combines medical ethicist and physician Joseph J. Fins’ mosaic approach to medical decision-making with the assent-based, adolescent medical decision-making approach. By doing so, the proposed framework not only mitigates the ethical concerns involved in surrogate decision-making but also enables the disability right of the minimally conscious to participate in their own medical decisions to the extent that their intermittent decision-making capacity permits.

Allie Bodin would like to thank their faculty sponsor Dr. Harold Braswell for their support of this project.