Deep Brain Stimulation, Neuroethics, and the Minimally Conscious State

Disorders of consciousness after acquired brain injury: the state of the science

“…Patients with DOC continue to encounter a health-care system that views their condition as hopeless and beyond remediation. 167 This pervasive n ihilism-a legacy of the right-to-die movement, which first affirmed choice at life's end 4 in cases such as Quinlan and Schiavo 168,169 -influences practice patterns, 170 viewing patients with severe brain injury through an end-of-life prism, leaving them marginalized and sequestered from the evolving fruits of neuroscience (J. J. Fins, u npublished work). 171 Institutional Review Board-approved interviews of families participating in research conducted at Weill Cornell Medical College and Liège University Hospital tell a counter-tale to the brilliant science that has been reviewed in the sections above (J. J. Fins, unpublished work).…”

“…If consent cannot be obtained because of decisional incapacity, it would seem logical to expand the discretion of surrogates to make judgements about research participation-with proper safeguards and assurances-especially if the objective of the intervention is to restore autonomous voices to individuals with DOC (J. J. Fins, unpublished work). 4,46,[186][187][188][189] A related topic is the use of guardianship. Though designed to protect the interests of decisionally incapacitated patients, and to make decisions that are consistent with the patient's previously expressed wishes and values, guardianship designations can sometimes deprive patients of their rights.…”

“…1 Moreover, advances in the assessment and rehabilitation of patients with the severe brain injuries that produce DOC have a t remendous impact on medical practice and ethics. [2][3][4] In this Review, we provide an overview of recent advances in the neurobiology, diagnosis and treatment of DOC, including the use of novel neuroimaging and electro physiological assessments. We also discuss the medicolegal and ethical issues surrounding these advances that will influence the medical care of patients with DOC.…”

Coma and consciousness: Paradigms (re)framed by neuroimaging

“…see Fins et al, 2008a;Fins and Schiff, 2010;Schiff et al, 2009). Only well-controlled large multi-center neuroimaging and electrophysiology studies will enable to identify which paraclinical diagnostic or prognostic test is necessary, at any given time, for our routine evidence based assessment of individuals with chronic disorders of consciousness.…”

Assessment and Intervention with Patients with Severe Disorders of Consciousness

“…Even so, great caution is required with respect to the use of this approach, as it remains an experimental, hospitalbased methodology, which has been subject to limited research evaluation and presents serious medical risks connected to the implantation and maintenance of the electrodes (Giacino et al 2012;Guerra et al 2014;Schiff et al 2007Schiff et al , 2009Yamamoto et al 2013).…”