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The neuroethics of disorders of consciousness: a brief history of evolving ideas.
Young, Michael J; Bodien, Yelena G; Giacino, Joseph T; Fins, Joseph J; Truog, Robert D; Hochberg, Leigh R; Edlow, Brian L.
  • Young MJ; Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
  • Bodien YG; Edmond J. Safra Center for Ethics, Harvard University, Cambridge, MA 02138, USA.
  • Giacino JT; Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
  • Fins JJ; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA 02129, USA.
  • Truog RD; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA 02129, USA.
  • Hochberg LR; Division of Medical Ethics, Weill Cornell Medical College, New York, NY 10021, USA.
  • Edlow BL; Yale Law School, New Haven, Connecticut 06511, USA.
Brain ; 144(11): 3291-3310, 2021 12 16.
Article in English | MEDLINE | ID: covidwho-1341106
ABSTRACT
Neuroethical questions raised by recent advances in the diagnosis and treatment of disorders of consciousness are rapidly expanding, increasingly relevant and yet underexplored. The aim of this thematic review is to provide a clinically applicable framework for understanding the current taxonomy of disorders of consciousness and to propose an approach to identifying and critically evaluating actionable neuroethical issues that are frequently encountered in research and clinical care for this vulnerable population. Increased awareness of these issues and clarity about opportunities for optimizing ethically responsible care in this domain are especially timely given recent surges in critically ill patients with prolonged disorders of consciousness associated with coronavirus disease 2019 around the world. We begin with an overview of the field of neuroethics what it is, its history and evolution in the context of biomedical ethics at large. We then explore nomenclature used in disorders of consciousness, covering categories proposed by the American Academy of Neurology, the American Congress of Rehabilitation Medicine and the National Institute on Disability, Independent Living and Rehabilitation Research, including definitions of terms such as coma, the vegetative state, unresponsive wakefulness syndrome, minimally conscious state, covert consciousness and the confusional state. We discuss why these definitions matter, and why there has been such evolution in this nosology over the years, from Jennett and Plum in 1972 to the Multi-Society Task Force in 1994, the Aspen Working Group in 2002 and the 2018 American and 2020 European Disorders of Consciousness guidelines. We then move to a discussion of clinical aspects of disorders of consciousness, the natural history of recovery and ethical issues that arise within the context of caring for people with disorders of consciousness. We conclude with a discussion of key challenges associated with assessing residual consciousness in disorders of consciousness, potential solutions and future directions, including integration of crucial disability rights perspectives.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Consciousness Disorders / Bioethical Issues / Neurology Type of study: Diagnostic study / Clinical Practice Guide / Prognostic study Limits: Humans Language: English Journal: Brain Year: 2021 Document Type: Article Affiliation country: Brain

Full text: Available Collection: International databases Database: MEDLINE Main subject: Consciousness Disorders / Bioethical Issues / Neurology Type of study: Diagnostic study / Clinical Practice Guide / Prognostic study Limits: Humans Language: English Journal: Brain Year: 2021 Document Type: Article Affiliation country: Brain