Tag Archives: minimally conscious state

Should We Ask Minimally Conscious Patients If They Want to Live?

Mo Constandi tackles this question in an excellent post reviewing the work of Adrian Owen, which I have been writing about myself.

Owen and Laureys have found a way to communicate with some of these patients, by posing questions to them as they lie inside a brain scanner. They ask patients to envision one of two scenarios, one if they mean to say “yes” and one for “no.” This raises the possibility of enabling these patients to make their own end-of-life decisions, but it also raises more ethical dilemmas. A big one: Should we even ask these patients if they wish to remain alive or die?

“That’s the question on everybody’s mind,” says Owen, “but it’s probably not appropriate to ask until we know what we will do with the answer. If a patient answers ‘Yes, I want to die,’ we still don’t have a procedure for allowing that to happen.” Most countries lack euthanasia laws; in those that do have them—such as Belgium and Switzerland—the vast majority of requests for euthanasia come from cancer patients; the laws are rarely, if ever, used in the context of patients with consciousness disorders.

Owen is collaborating with neuroethicist Judy Illes of the University of British Columbia to address these issues. With funding from the Canadian Institutes of Health Research, they are focusing on how these new technologies can provide information about such patients, how the tools could be incorporated into healthcare systems, and what they mean for patients, their families, and society.

“The question is how we can use this technology most beneficially,” says Illes, also a member of the Dana Alliance for Brain Initiatives. “It’s tempting to ask about end-of-life decisions, but that’s probably inappropriate. I think one of the best questions to ask is ‘Are you in pain?’ because that’s something we could respond to immediately.”

Patients could, she adds, also be asked about how their daily lives might be made more comfortable and enjoyable. “We might ask about their preferences for food or entertainment. Something that seems trivial to you and I may be super-important to somebody who is unable to do anything except lie in their bed.”

– See more at: http://dana.org/News/Details.aspx?id=43226#sthash.2TPWLZTR.dpuf

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Quote of the day – Depth of Processing in the Vegetative State

“In the [vegetative state] or [minimally conscious state] the EEG is by definition not flat and typically shows widespread slowing of brain rhythms. Does this mean that nothing is being processed? The answer is a definite ‘no’. A clear analogy is the emerging literature on the depth of processing of environmental input (i.e., the surgeon talking about something in the operating room) while the patient is under anesthesia with widespread EEG slowing akin to that observed in VS and MCS. By this logic it would be surprising if some sensory input were not being processed in all VS patients and certainly in all MCS patients. By extension, one might also propose that some internal thoughts are being generated in these devastating clinical states.

Indeed, the key issue from the neurologist’s perspective is whether the neurological insult, whether prolong hypoxia or severe traumatic brain injury, will leave any meaningful brain function. So, it is not clear if the key issue is ‘consciousness’ or the clinical experience with these patients per long-term recovery of ‘meaningful’ life. Of course, meaningful is as poorly defined as consciousness and herein lies the quandary.”

~ Robert Knight, (2008) “Consciousness Unchained: Ethical Issues and the Vegetative and Minimally Conscious State” The American Journal of Bioethics, 8(9): 1–2

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