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Observations on the Ethical and Social Aspects of Disorders of Consciousness

Published online by Cambridge University Press:  23 September 2016

Eric Racine ,
Catherine Rodrigue ,
James L. Bernat ,
Richard Riopelle  and
Sam D. Shemie
Eric Racine*
Affiliation:
Neuroethics Research Unit, Department of Medicine and Department of Social and Preventive Medicine, Université de Montréal Department of Neurology and Neurosurgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada Biomedical Ethics Unit, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
Catherine Rodrigue
Affiliation:
Neuroethics Research Unit, Department of Medicine and Department of Social and Preventive Medicine, Université de Montréal
James L. Bernat
Affiliation:
Neurology Department, Dartmouth-Hitchcock, Medical Center, Lebanon, New Hampshire, USA
Richard Riopelle
Affiliation:
Department of Neurology and Neurosurgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
Sam D. Shemie
Affiliation:
Division of Pediatric Critical Care, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
*
Neuroethics Research Unit, Institut de recherches cliniques de Montréal (IRCM), 110 avenue des Pins Ouest, Montréal, Québec, H2W lR7, Canada
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Abstract

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The care of chronically unconscious patients raises vexing medical, ethical, and social questions concerning diagnosis, prognosis, communication with family members, and decision making, including the withdrawal of life support. We provide updates on major controversies surrounding disorders of consciousness. Issues such as withdrawal of artificial nutrition and hydration – which had been considered “settled” by many in the medical, legal and ethical communities – have resurfaced under the pressure of social groups and religious authorities. Some assumptions about the level of awareness and the prognosis of vegetative state and minimal conscious patients are questioned by advances in clinical care because of insights produced by neuroscience research techniques, particularly functional neuroimaging. Both the clinical and neuroscience dimensions of disorders of consciousness raise complex issues such as resource allocation and high levels of diagnostic inaccuracies (at least, for the vegetative state). We conclude by highlighting areas needing further research and collaboration.

Résumé

Résumé

La prise en charge de patients inconscients chronique soulève des questions médicales, éthiques et sociales qui sont éprouvantes en ce qui concerne le diagnostic, le pronostic, la communication avec les membres de la famille et les décisions à prendre, dont le retrait des mesures de maintien en vie. Nous faisons une mise à jour des grandes controverses concernant les troubles de la conscience. Les controverses telles le retrait de la nutrition artificielle et de l'hydratation - qui étaient considérées comme résolues par plusieurs membres des communautés médicale, légale et éthique - ont refait surface sous la pression de groupes sociaux et d'autorités religieuses. Certaines notions au sujet du niveau de conscience et du pronostic de l'état végétatif et les patients minimalement conscients, qui étaient tenues pour acquises, sont remises en question à cause des progrès dans les soins cliniques découlant des techniques de recherche en neurosciences, particulièrement de l'imagerie fonctionnelle. Les dimensions cliniques et neuroscientifiques des troubles de la conscience soulèvent des enjeux complexes tels l'allocation des ressources et le taux élevé d'inexactitudes diagnostiques (du moins pour l'état végétatif). En conclusion, nous soulignons les domaines dans lesquels des recherches et des collaborations plus poussées sont nécessaires.

Type
Review Articles
Information
Canadian Journal of Neurological Sciences , Volume 37 , Issue 6 , November 2010 , pp. 758 - 768
Copyright
Copyright © The Canadian Journal of Neurological 2010

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