Neuroscience is defining our understanding of mental states through models of consciousness.This endeavor is enriched by technological surveillance which can detect the signatures of neurophysiological activity of conscious mental processes.Functional MRI (fMRI) detects volumetric blood-flow patterns that presumably indicate metabolic activity of interlinked neuron networks creating the facets of the mind.It is now possible, to some degree, to determine what someone is thinking by monitoring their brains metabolic activity.This technology has found a variety of commercial applications, from "neuromarketing" research to lie detection.In the clinical setting, patients in severely altered conscious states can present a diagnostic challenge with clinical implications: there is a spectrum of cognitive impairment severity that correlates with prognostic outcomes.In addition, ethical dilemmas arise which must be considered.It is estimated that over 1/3 of patients diagnosed as vegetative are actually minimally conscious which carries a better prognosis, but the misdiagnosis implies that patients with some degree of self and environmental awareness may receive inappropriate treatment.In has been reported that fMRI can detect conscious awareness in otherwise noncommunicative unresponsive patients.Unfortunately, many patients are diagnosed as vegetative and it would be impractical to implement a diagnostic protocol with fMRI evaluation as a standard of care due to the large volume of potential candidates, limited resources, and sociopolitical pressures to contain (and reduce) healthcare expenditures.In addition to the detection of conscious states, technology also offers ways for the impaired to interact with the outside world enhancing their quality of life.The stratification and welfare of these patients presents challenges for the neuroscience and clinical communities, ethicists and healthcare policy makers.