From Awareness to Prognosis: Ethical Implications of Uncovering Hidden Awareness in Behaviorally Nonresponsive Patients

Abstract

Abstract:Long-term patient outcomes after severe brain injury are highly variable, and reliable prognostic indicators are urgently needed to guide treatment decisions. Functional neuroimaging is a highly sensitive method of uncovering covert cognition and awareness in patients with prolonged disorders of consciousness, and there has been increased interest in using it as a research tool in acutely brain injured patients. When covert awareness is detected in a research context, this may impact surrogate decisionmaking—including decisions about life-sustaining treatment—even though the prognostic value of covert consciousness is currently unknown. This paper provides guidance to clinicians and families in incorporating individual research results of unknown prognostic value into surrogate decisionmaking, focusing on three potential issues: (1) Surrogate decisionmakers may misinterpret results; (2) Results may create false hope about the prospects of recovery; (3) There may be disagreement about the meaningfulness or relevance of results, and appropriateness of continued care.

Public Awareness of the Traditional and Complementary Medicine Act Governing Chiropractic in Malaysia: A Survey of Adults in Klang Valley

“…While some might argue that discussing an “Act” could detract from valuable treatment time, it is an invaluable investment in patient education and trust-building. 33 Ensuring compliance with the act not only safeguards the public by guaranteeing standardized care but also reinforces the credibility of the chiropractic profession. It serves as a testament to the profession's commitment to transparency, quality, and, above all, patient safety.…”

Uncovering Consciousness and Revealing the Preservation of Mental Life in Unresponsive Brain-Injured Patients

“…Therefore, ethical guidelines for the dissemination of research results to surrogate decision makers and medical teams are urgently needed. 75,76 Additionally, as aforementioned, consensus guidelines for the standardization of testing parameters and data analyses pipelines across different groups are necessary to ensure reliability and robustness of these assessment protocols for clinical use. system.…”

Clinical Decision‐Making for Patients with Disorders of Consciousness

“…Diagnostic pitfalls include the failure to detect covert consciousness leading to false‐positive diagnoses of UWS/VS, as van Erp and colleagues emphasized. Prognostic pitfalls include the fallacy of the self‐fulfilling prophecy.…”

“…How physicians frame their presentation of information to families exerts a powerful effect on surrogates' decisions, and negative framing is correlated with surrogate decisions to terminate life-sustaining treatment. 7 Diagnostic pitfalls include the failure to detect covert consciousness leading to false-positive diagnoses of UWS/ VS, 8 as van Erp and colleagues emphasized. Prognostic pitfalls include the fallacy of the self-fulfilling prophecy.…”