Covert Consciousness, Cognitive Bias, and Medical Hubris
Updated: Apr 14
The apostle Paul wrote in 1 Corinthians 2:11: “For who knows a person’s thoughts except their own spirit within them?” In this verse, Paul states the obvious: we can only know our thoughts, not those of another person. While the entire section in 1 Corinthians 2 (vv. 10 –16) focuses on the Holy Spirit’s role in revealing the wisdom of God, Paul’s rhetorical question addresses an important issue relevant to diagnosing death by making presumptions about the end of another person’s mental life.
When performing Cognitive Behavioral Therapy (CBT), the counselor must be aware of cognitive bias, which is thinking based on speculation. People think they know something, even when they do not have all the facts. One type of cognitive bias is mind reading, which may indicate a mental disorder rooted in narcissism. Mind reading is the presumption that another person’s mental state can be known without direct information from that person. Unconscious people on a ventilator diagnosed as “brain dead,” or having no mental life, are subjected to the worst form of mind reading and cognitive bias.
Advances in modern neuroscience warrant caution when it comes to speculating about another person’s mental state. Since the ground-breaking discovery of a “persistent vegetative state” (PVS) made by Fred Plum, MD, in 1972, he found that the condition was not always permanent, and in some cases, it could be reversed. It is also a well-known medical fact that after a head trauma, time to decrease intracranial swelling and neuroprotective strategies can foster healing in the brain. The science journal Nature published an article in 2000 showing evidence of damaged neurons regenerating in the central nervous system. Also, new neural networks may form through neuroplasticity to promote healing in the brain.
Misdiagnosis is a significant problem when interpreting a nonresponsive person’s mental state. A 1996 BMJ study found that 17 of 40 participants thought to be in a vegetative state were misdiagnosed, and one-third experienced recovery during the research period. Even more horrifying is a study published in 2009 revealing that harvesting organs “from patients with impaired consciousness is in reality a concealed practice of physician-assisted death, and therefore violates both the criminal laws and the central tenet of medicine of do-no-harm principle.” Since we share a common humanity, we have some insight into each other’s thoughts and feelings, but only the most arrogant claim the ability to know other people’s mental states.
In philosophy, this is referred to as the epistemological problem of other minds. Of course, today’s prevailing belief is that no mind exists and only a brain that secretes mental events does. However, even after a couple of centuries of research, neuroscientists have only begun to scratch the surface of the complex interplay between neurons, dendrites, synapses, and neurotransmitters—the brain. Never mind providing scientific explanations to explain how neurochemical activity in the brain becomes consciousness, a dream, thought, idea, or belief. While commonsense points us toward a master integrator, such as “their own spirit within them,” the whole-brain criterion of the Uniform Determination of Death Act (UDDA) says no. Nevertheless, the epistemological problem of other minds stands.
Rene Descartes famously said, “I think therefore I am,” which gets to the heart of the problem of other minds. I can know my mind from an evidential standpoint, but only to a limited extent. I have conscious experiences when I’m awake. At times, I have subconscious experiences when sleeping. Technically, I have no mental events if I don’t dream while sleeping. Nevertheless, my heart beats, and my lungs aerate, so I’m not dead, even though I’m unconscious. The only significant difference is that I’m not on a ventilator. Most importantly, however, I have no way of knowing what it is like to be in this unconscious state because I do not have experiential data about it. I’m not thinking, feeling, or dreaming, but I still exist. Since I cannot know my unconsciousness, how can I possibly understand the mental state of another nonresponsive person with a beating heart and aerating lungs on a ventilator? After all, Terry Wallis awoke after 19 years!
Thankfully, we don’t have to read other people’s minds because those who were once declared “brain dead” and others with a non-functioning brainstem can speak for themselves. The BMJ, “A survey on self-assessed well-being in a cohort of chronic locked-in syndrome patients: happy majority, miserable minority,” found that 72 percent reported they were happy, and only 7 percent expressed a wish for euthanasia. People with locked-in syndrome have quadriplegia and may depend on a ventilator to live, but their higher brain still functions. As for those who were once “brain-dead” and recovered, 100 percent reported thankfulness and joy. We can only speculate about those in vegetative and minimally conscious states, never mind the terror a neurologically impaired organ donor may experience during an “honor walk.” The knowledge of their mental state rests solely with those individuals and God (Ps. 139:2), not those narcissistic physicians stricken with a case of medical hubris.