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In the field of science, the preservation of consciousness is a core issue. It is also a core issue in the field of medicine. It is also a core issue in the field of philosophy, and it is a cutting-edge issue full of challenges. It is not just limited to maintaining vital signs, but also involves how to define various complex states of consciousness, from deep coma to normal awakening. It’s also about how to measure these states of consciousness and how to intervene in them. Modern science is conducting unprecedented in-depth exploration of the preservation of consciousness from the level of neurobiological mechanisms. Modern science is also conducting unprecedented in-depth exploration from the clinical diagnostic technology level. In addition, modern science is also conducting unprecedented in-depth exploration of the preservation of consciousness from multiple levels such as ethics and law.

How the brain actively restarts consciousness from anesthesia

The traditional view is that awakening after anesthesia is a passive drug metabolism state. However, the "active restart theory of consciousness" proposed by the team of Professor Song Xuejun of Southern University of Science and Technology has overturned this understanding. This theory shows that the brain's recovery from unconsciousness is a "reawakening" process actively promoted by specific neural circuits and molecular signals. The study found that glutamatergic neurons in the ventral posteromedial nucleus of the thalamus play a key role. There is a dual-channel cooperation mechanism similar to "accelerator" and "brake". The EphB1-NR2B signaling pathway activates neurons, and the EphB1-KCC2 pathway relieves the inhibition of neurons by anesthesia. This active restart mechanism has been elucidated, which not only explains the reasons for delayed recovery in some patients after surgery, but also provides new molecular targets for the treatment of disorders of consciousness.

The theory of active restart of consciousness has been proposed, which means that our understanding of consciousness restoration has changed from passive to active. This suggests that clinical intervention measures cannot simply wait for the drug to be metabolized, but must consider how to accurately regulate those intrinsic neural restart mechanisms. For example, in the future, it is very likely that drugs targeting EphB1 and other similar proteins, or neuromodulation technology, will be used to provide proactive assistance to patients who face difficulty in recovering consciousness. This has opened up new intervention ideas and treatment directions for clinical problems such as coma-induced awakening.

Which brain regions are critical for maintaining consciousness

For a long time, the scientific community has always adhered to the "cortex-centrism", believing that the cerebral cortex is the only basic basis for conscious experience. However, there is increasing evidence that subcortical structures, especially the brainstem, are absolutely indispensable for maintaining a basic form of consciousness. Observations of children with congenital acortex (hydroceleencephaly) and corticalized animals have confirmed that even without a cerebral cortex, organisms can still exhibit sleep-wake cycles, emotional responses to noxious stimuli, etc., which is defined as "emotional consciousness." It is the evolutionary predecessor of human beings’ much more complex “reflective consciousness.”

First, the brainstem functions through functional integration with other subcortical structures such as the amygdala and motor system, thereby forming the basis of a neural network that supports emotional awareness. Second, this system is like a "selection triangle" that integrates body movements, external world information, and personal motivations to produce instinctive emotional goal-directed behaviors. Finally, this realization has profound clinical and ethical implications, suggesting that some patients diagnosed with a "vegetative state" may still retain basic emotional awareness. Therefore, during clinical assessment and treatment decision-making, it is necessary to distinguish between emotional awareness and reflective awareness, which is directly related to respect for the patient's inner experience and corresponding ethical responsibilities.

How to quantitatively assess a person’s level of consciousness

In clinical practice, accurately measuring the level of consciousness of patients with disorders of consciousness is a great challenge. Currently, the scientific community is focusing its efforts on finding objective and quantitative neurobiological markers. Functional magnetic resonance imaging technology provides a powerful tool for this goal by analyzing the dynamic changes in the brain's functional connection network. Research shows that the activity characteristics of the conscious waking brain are abundant, dynamic, and have high entropy values, and can flexibly switch between different functional connection modes.

When consciousness is lost, whether due to anesthesia or sleep, brain activity is dominated by a dominant pattern driven primarily by structural connections that reoccurs, and its ability to switch to other patterns is significantly reduced. This gives a potentially universal signature for distinguishing conscious from unconscious states. For example, in the "response disconnection" state caused by deep sedation with dexmedetomidine, that is, when the patient is unresponsive but may retain inner awareness, the functional integration of the brain's low-level sensory networks and the communication between networks will be disrupted, but the functions of the higher-level networks are relatively preserved. This specific change in network topology may be a "signature" on brain activity at different levels of consciousness.

Can consciousness be artificially enhanced or modulated?

As the understanding of the neural mechanism of consciousness continues to deepen, using technological means to intervene or even enhance consciousness is no longer a science fiction category. At present, biotechnological intervention methods such as drugs, electrical stimulation, and cell replacement therapy have shown the potential to modulate consciousness at the therapeutic level. For example, ketamine, at sub-anesthetic doses, can produce a unique dissociative state, changes in perception, and a series of other conditions. Its brain activity characteristics are more similar to the conscious state caused by hallucinogens, rather than the traditional unconscious state.

The technology derived from clinical diagnosis and treatment may eventually benefit a wider range of people and be used to enhance the cognitive functions of healthy individuals. This is moving in the direction of cutting-edge exploration of "beyond human consciousness", that is, using the integration of biotechnology and silicon-based technology to fundamentally expand the boundaries of human consciousness. For example, developing brain-computer interfaces to enhance perception, memory or attention. Such research is bound to spark profound philosophical and ethical discussions about free will, the nature of the self, and how to define the moral status and rights of sentient entities.

What is the “hard problem of consciousness” faced by philosophy?

Despite the rapid progress of neuroscience, the study of consciousness still faces fundamental philosophical challenges, known as the "hard problem of consciousness": why and how does the physical brain produce subjective, first-person experiences? Some philosophers feel that the cognitive limitations of human beings and the existing conceptual framework may mean that we will never be able to comprehensively solve this problem. When we think about consciousness, we rely extremely heavily on the concepts of "composition" and "instantiation" (like parts and wholes, properties and objects), but both of them have their own shortcomings when dealing with the relationship between mind and body.

The compositional relationship can explain how disparate parts form a whole, but it is difficult to cross the ontological gap between "objects" and "properties", such as how neurons constitute "pain" as an experience. The instantiation relationship can connect objects with attributes, but it only stipulates that the object must exhibit the characteristics of the attribute. There is no way to explain why brain tissue that appears gray and has moist characteristics instantiates colorful subjective feelings. This fundamental conceptual dilemma has led to ongoing debates around issues such as multiple realizability, philosophical zombies, psychological causality, and panpsychism, highlighting the critical importance of interdisciplinary dialogue for understanding the nature of consciousness.

What are the ethical and legal challenges of preserving consciousness?

Research on the preservation of consciousness directly impacts the existing ethical and legal frameworks. The most fundamental challenge lies in how we define the survival and autonomy of "people" when a person's consciousness changes (such as falling into a vegetative state or a minimally conscious state). As for sex and interests, if the "emotional consciousness" supported by the brainstem still exists without the cortex, then is it enough to provide basic life support to this type of patients? Do we have a certain obligation to detect and try to maintain their possible remaining inner experiences?

Another challenge arises from the prospect of enhanced consciousness and artificial consciousness. If future technology can significantly enhance the consciousness of normal people, or create artificial intelligence or brain organoids with certain forms of consciousness, then how will society deal with the resulting inequality, identity crisis, and new rights subjects? Does the concept of “person” in law need to be expanded? The answers to these questions must not only be based on science, but also rely on the whole society to carry out extensive and prudent public discussions at the philosophical, ethical and value levels.

Among your views is that if future technology can objectively read a person's basic emotional consciousness, how will this change our medical decisions and ethical responsibilities for patients with vegetative states? We look forward to sharing your insights in the comment area. If you find this article inspiring, please feel free to like and share it.