Can digital brain twins dissolve the uncertainties surrounding unresponsive wakefulness?

Unresponsive Wakefulness Syndrome (UWS), a condition characterized by wakefulness without awareness, presents significant medical and moral uncertainties, particularly in end-of-life decision-making. Digital Brain Twins (DBTs), virtual replicas of patients’ brains driven by advanced artificial intelligence, offer the potential to alleviate medical uncertainties by providing precise diagnoses, prognoses, and experimental platforms for treatment testing. This paper provides a theoretical contribution by examining the potential ethical impact of these technologies in the context of UWS. We argue that, while DBTs promise greater diagnostic accuracy, personalized predictions of recovery, and non-invasive tools for exploring therapeutic interventions, they do not necessarily resolve the moral uncertainties faced by proxy decision-makers. Decisions about withdrawing or continuing life-sustaining treatment are fundamentally moral and value-laden, often extending beyond empirical evidence provided by DBTs. Factors such as cognitive biases, emotional distress, and subjective interpretations of best interest further complicate these decisions. While DBTs represent a breakthrough in precision medicine, their role in navigating the ethical complexities of UWS is limited, emphasizing the need for integrated approaches that combine technological innovation with ethical and psychological support for proxies.