Disorders of consciousness

Disorders of consciousness

Patients in coma, vegetative, or minimally conscious state pose ethical challenges. The patients are unable to respond, therefore the assessment of their needs can only be approached by adopting a third person perspective. They are unable to communicate their pain levels, quality of life, or end of life preferences. Neuroscience and brain imaging have allowed us to explore the brain activity of these patients more thoroughly. Recent findings from studies using functional magnetic resonance imaging have changed the way we view vegetative patients. The images have shown that aspects emotional processing, language comprehension and even conscious awareness might be retained in patients whose behavior suggests a vegetative state. If this is the case, it is unethical to allow a third party to dictate the life and future of the patient. For example, defining death is an issue that comes with patients with severe traumatic brain injuries. The decision to withdraw life-sustaining care from these patients can be based on uncertain assessments about the individual’s conscious awareness. Case reports have shown that these patients in a persistent vegetative state can recover unexpectedly. This raises the ethical question about the premature termination of care by physicians. The hope is that one day, neuroimaging technologies can help us to define these different states of consciousness and enable us to communicate with patients in vegetative states in a way that was never before possible. The clinical translation of these advanced technologies is of vital importance for the medical management of these challenging patients. In this situation, neuroscience has both revealed ethical issues and possible solutions.