Unlocking the Voices of Patients with Severe Brain Injury

Peterson, Andrew; Mintz, Kevin; Owen, Adrian M.

doi:10.1007/s12152-022-09492-0

Cited by 7 publications

(14 citation statements)

References 56 publications

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“…It gives rise to the possibility that one day, reliable and consistent BCI communication with these patients may be feasible 6 , 7 . In any case, as Peterson and colleagues point out, already today, neuroimaging allows us for instance to ask whether they are in pain ( 18 ). This is an accomplishment of major importance as this could greatly improve the pain management and, consequently, the well-being of a patient.…”

Section: Disorders Of Consciousness and Neuroimagingmentioning

confidence: 99%

“…In general, the law operates under a rebuttable presumption that adults possess decision-making capacity. It is only when there are signs that suggest that the patient's decision-making capacity is impaired, that medical professionals have to make an in-depth assessment ( 18 ). As decision-making capacity is considered task-specific, this capacity assessment must be tailored to the specific decision that is to be made.…”

Section: Competence and Informed Consentmentioning

confidence: 99%

“…Depending on the context, different assessment tools may be used. Although there is not one unique accepted standardized instrument ( 28 ), the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), a tool created by Grisso and Applebaum ( 29 ), stands out as the golden standard for the assessment of patients' competence within the clinical context ( 18 ). Using the MacCAT-T, medical professionals evaluate a patient's decision-making capacity by conducting a semi-structured interview that aims at establishing whether the patient is able to understand, reason, appreciate the given information and treatment options, and communicate their choice.…”

Section: Competence and Informed Consentmentioning

confidence: 99%

“…In a more recent article, Peterson and colleagues suggest a different framework for aligning the specificities of the procedure of obtaining informed consent via neuroimaging, with the requirements for informed consent. Accompanied by a disclaimer that their “proposal is speculative, has not been applied in practice, and might ultimately be unfeasible” [( 18 ), p. 13], the authors set forth an interpretation of the MacCAT-T tailored to neuroimaging techniques in the form of a vignette approach. In short, they suggest that it might be possible to formulate highly refined snapshots of medical information–vignettes–and then ask the patient yes-or-no questions about these vignettes.…”

Section: Disorders Of Consciousness and Informed Consentmentioning

confidence: 99%

“…In short, they suggest that it might be possible to formulate highly refined snapshots of medical information–vignettes–and then ask the patient yes-or-no questions about these vignettes. The answers to these questions will reveal information relevant to the patient's decision-making capacity as, for example, “correctly responding to factual questions might demonstrate the ability to understand relevant medical information, while correctly responding to questions about hypothetical scenarios might demonstrate consequential reasoning, or the ability to appreciate how different treatment decisions will affect one's medical condition” [( 18 ), p. 8].…”

Section: Disorders Of Consciousness and Informed Consentmentioning

confidence: 99%

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Empowering the voiceless. Disorders of consciousness, neuroimaging and supported decision-making

Istace

2022

Front. Psychiatry

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Patients suffering from (Prolonged) Disorder of Consciousness are deemed incompetent to give valid informed consent due to the presumed impairment of their cognitive functions and the impossibility to communicate with them. Neuroscientists have, however, discovered ways in which communication with some of these patients might be possible by using neuroimaging. This would for the first time make it possible to include them in the decision-making on their own medical treatment. In this article, I elaborate on the prospect of communicating with patients with impaired consciousness in order to obtain their informed consent. I first map the current state-of-the-art in neuroimaging research that exhibits the possibility of communicating with some of these patients. Secondly, I examine how obtaining informed consent from these patients might be possible, given that the specificities and limitations of communication via neuroimaging render the task of assessing their competence rather difficult. Thirdly, I identify some of the important ethical and legal considerations that have to be taken into account before introducing neuroimaging in clinical practice as a means to obtain informed consent. Lastly, I look into the concept of supported decision-making and how this concept relates to the use of neurotechnology to support minimally conscious patients in their abilities to decide over their own medical treatment.

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Section: Disorders Of Consciousness and Neuroimagingmentioning

confidence: 99%

Section: Competence and Informed Consentmentioning

confidence: 99%

Section: Competence and Informed Consentmentioning

confidence: 99%

Section: Disorders Of Consciousness and Informed Consentmentioning

confidence: 99%

Section: Disorders Of Consciousness and Informed Consentmentioning

confidence: 99%

See 3 more Smart Citations

Empowering the voiceless. Disorders of consciousness, neuroimaging and supported decision-making

Istace

2022

Front. Psychiatry

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Deciding with Others: Interdependent Decision‐Making

Largent¹,

Clapp²,

Blumenthal‐Barby³

et al. 2022

Hastings Center Report

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Over the course of human life, health care decision‐making is often interdependent. In this article, we use “interdependence” to refer to patients’ engagement of nonclinicians—for example, family members or trusted friends—to reach health care decisions. Interdependence, we suggest, is common for patients in all stages of life, from early childhood to late adulthood. This view contrasts with the common bioethical assumption that medical decisions are either wholly independent or dependent and that independence or dependence is tightly coupled with a person's decision‐making capacity. In this article, we array various approaches to decision‐making along a continuum of interdependence. An appreciation of this continuum can empower patients and elucidate ethical challenges that arise when people transition between different kinds of interdependence across the life span.

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Neural Voices of Patients with Severe Brain Injury?

Owen,

Hight,

Hudetz

2025

Camb Q Healthc Ethics

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Studies have shown that some covertly conscious brain-injured patients, who are behaviorally unresponsive, can reply to simple questions via neuronal responses. Given the possibility of such neuronal responses, Andrew Peterson et al. have argued that there is warrant for some covertly conscious patients being included in low-stakes medical decisions using neuronal responses, which could protect and enhance their autonomy. The justification for giving credence to alleged neuronal responses must be analyzed from various perspectives, including neurology, bioethics, law, and as we suggest, philosophy of mind. In this article, we analyze the warrant for giving credence to neuronal responses from two different views in philosophy of mind. We consider how nonreductive physicalism’s causal exclusion problem elicits doubt about interpreting neural activity as indicating a conscious response. By contrast, such an interpretation is supported by the mind-body powers model of neural correlates of consciousness inspired by hylomorphism.

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Unlocking the Voices of Patients with Severe Brain Injury

Cited by 7 publications

References 56 publications

Empowering the voiceless. Disorders of consciousness, neuroimaging and supported decision-making

Empowering the voiceless. Disorders of consciousness, neuroimaging and supported decision-making

Deciding with Others: Interdependent Decision‐Making

Neural Voices of Patients with Severe Brain Injury?

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