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Farisco M, Formisano R, Gosseries O, Kato Y, Koboyashi S, Laureys S, Lejeune N, Martial C, Matar A, Morrisey AM, Schnakers C, Yakufujiang M, Yamaki T, Veeramuthu V, Zandalasini M, Zasler N, Magliacano A, Estraneo A. International survey on the implementation of the European and American guidelines on disorders of consciousness. J Neurol 2024; 271:395-407. [PMID: 37740739 PMCID: PMC10770208 DOI: 10.1007/s00415-023-11956-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/25/2023]
Abstract
Diagnostic, prognostic, and therapeutic procedures for patients with prolonged disorders of consciousness (pDoCs) vary significantly across countries and clinical settings, likely due to organizational factors (e.g., research vs. non-academic hospitals), expertise and availability of resources (e.g., financial and human). Two international guidelines, one from the European Academy of Neurology (EAN) and one from the American Academy of Neurology (AAN) in collaboration with the American Congress of Rehabilitation Medicine (ACRM) and the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), were developed to facilitate consistent practice among professionals working with this challenging patient population. While the recommendations of both guidelines agree in principle, it remains an open issue how to implement them into clinical practice in the care pathway for patients with pDoCs. We conducted an online survey to explore health professional clinical practices related to the management of patients with pDoCs, and compare said practices with selected recommendations from both the guidelines. The survey revealed that while some recommendations are being followed, others are not and/or may require more honing/specificity to enhance their clinical utility. Particular attention should be given to the implementation of a multimodal assessment of residual consciousness, to the detection and treatment of pain, and to the impact of restrictions imposed by COVID-19 pandemics on the involvement of patients' families/representatives.
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Affiliation(s)
- Michele Farisco
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden.
- Biogem, Biology and Molecular Genetics Research Institute, Ariano Irpino, AV, Italy.
| | | | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Yoko Kato
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Shigeki Koboyashi
- Division of Neurosurgery, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, 3-30-1 Isobe, Mihamaku, Chibashi, Chiba, 261-0012, Japan
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
- CERVO Brain Research Center, University of Laval, Québec, QC, Canada
| | - Nicolas Lejeune
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- CHN William Lennox, Ottignies-Louvain-La Neuve, Belgium
- Institute of NeuroScienceUCLouvain, Ottignies-Louvain-La Neuve, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Amal Matar
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden
| | - Ann-Marie Morrisey
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, USA
| | - Maidinamu Yakufujiang
- Division of Neurosurgery, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, 3-30-1 Isobe, Mihamaku, Chibashi, Chiba, 261-0012, Japan
| | - Tomohiro Yamaki
- Division of Neurosurgery, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, 3-30-1 Isobe, Mihamaku, Chibashi, Chiba, 261-0012, Japan
| | | | - Matteo Zandalasini
- Unità Spinale, Neuroriabilitazione E Medicina Riabilitativa Intensiva, Dipartimento Di Medicina Riabilitativa, Azienda USL Di Piacenza, Piacenza, Italy
| | - Nathan Zasler
- Concussion Care Centre of Virginia, LTD, Henrico, VA, 23233, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Alfonso Magliacano
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence and Sant'Angelo dei Lombardi, AV, Italy
| | - Anna Estraneo
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence and Sant'Angelo dei Lombardi, AV, Italy
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Ishida S, Nishitsutsumi Y, Kashioka H, Taguchi T, Shineha R. A comparative review on neuroethical issues in neuroscientific and neuroethical journals. Front Neurosci 2023; 17:1160611. [PMID: 37781239 PMCID: PMC10536163 DOI: 10.3389/fnins.2023.1160611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
This study is a pilot literature review that compares the interest of neuroethicists and neuroscientists. It aims to determine whether there is a significant gap between the neuroethical issues addressed in philosophical neuroethics journals and neuroscience journals. We retrieved 614 articles from two specialist neuroethics journals (Neuroethics and AJOB Neuroscience) and 82 neuroethics-focused articles from three specialist neuroscience journals (Neuron, Nature Neuroscience, and Nature Reviews Neuroscience). We classified these articles in light of the neuroethical issue in question before we compared the neuroethical issues addressed in philosophical neuroethics with those addressed by neuroscientists. A notable result is a parallelism between them as a general tendency. Neuroscientific articles cover most neuroethical issues discussed by philosophical ethicists and vice versa. Subsequently, there are notable discrepancies between the two bodies of neuroethics literature. For instance, theoretical questions, such as the ethics of moral enhancement and the philosophical implications of neuroscientific findings on our conception of personhood, are more intensely discussed in philosophical-neuroethical articles. Conversely, neuroscientific articles tend to emphasize practical questions, such as how to successfully integrate ethical perspectives into scientific research projects and justifiable practices of animal-involving neuroscientific research. These observations will help us settle the common starting point of the attempt at "ethics integration" in emerging neuroscience, contributing to better governance design and neuroethical practice.
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Affiliation(s)
- Shu Ishida
- Graduate School of Life Sciences, Tohoku University, Sendai, Japan
| | - Yu Nishitsutsumi
- Center for Information and Neural Networks, National Institute of Information and Communications Technology, Suita, Japan
| | - Hideki Kashioka
- Center for Information and Neural Networks, National Institute of Information and Communications Technology, Suita, Japan
| | - Takahisa Taguchi
- Center for Information and Neural Networks, National Institute of Information and Communications Technology, Suita, Japan
| | - Ryuma Shineha
- Research Center on Ethical, Legal, and Social Issues, Osaka University, Suita, Japan
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Farisco M, Salles A. American and European Guidelines on Disorders of Consciousness: Ethical Challenges of Implementation. J Head Trauma Rehabil 2022; 37:258-262. [PMID: 35417436 DOI: 10.1097/htr.0000000000000776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Michele Farisco
- Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden (Drs Farisco and Salles); Science and Society Unit, Biogem, Biology and Molecular Genetics Institute, Via Camporeale, Ariano Irpino (AV), Italy (Dr Farisco); and Programa de Neuroetica, Centro de Investigaciones Filosoficas, Buenos Aires, Argentina (Dr Salles)
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Farisco M, Pennartz C, Annen J, Cecconi B, Evers K. Indicators and criteria of consciousness: ethical implications for the care of behaviourally unresponsive patients. BMC Med Ethics 2022; 23:30. [PMID: 35313885 PMCID: PMC8935680 DOI: 10.1186/s12910-022-00770-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/13/2022] [Indexed: 11/24/2022] Open
Abstract
Background Assessing consciousness in other subjects, particularly in non-verbal and behaviourally disabled subjects (e.g., patients with disorders of consciousness), is notoriously challenging but increasingly urgent. The high rate of misdiagnosis among disorders of consciousness raises the need for new perspectives in order to inspire new technical and clinical approaches.
Main body We take as a starting point a recently introduced list of operational indicators of consciousness that facilitates its recognition in challenging cases like non-human animals and Artificial Intelligence to explore their relevance to disorders of consciousness and their potential ethical impact on the diagnosis and healthcare of relevant patients. Indicators of consciousness mean particular capacities that can be deduced from observing the behaviour or cognitive performance of the subject in question (or from neural correlates of such performance) and that do not define a hard threshold in deciding about the presence of consciousness, but can be used to infer a graded measure based on the consistency amongst the different indicators. The indicators of consciousness under consideration offer a potential useful strategy for identifying and assessing residual consciousness in patients with disorders of consciousness, setting the theoretical stage for an operationalization and quantification of relevant brain activity. Conclusions Our heuristic analysis supports the conclusion that the application of the identified indicators of consciousness to its disorders will likely inspire new strategies for assessing three very urgent issues: the misdiagnosis of disorders of consciousness; the need for a gold standard in detecting consciousness and diagnosing its disorders; and the need for a refined taxonomy of disorders of consciousness.
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Affiliation(s)
- Michele Farisco
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden. .,Science and Society Unit, Biogem, Biology and Molecular Genetics Research Institute, Ariano Irpino, AV, Italy.
| | - Cyriel Pennartz
- Department of Cognitive and Systems Neuroscience, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, The Netherlands.,Research Priority Area, Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Jitka Annen
- Coma Science Group, GIGA-Consciousness, University of Liege, Liege, Belgium.,Centre du Cerveau, University Hospital of Liege, Liege, Belgium
| | - Benedetta Cecconi
- Coma Science Group, GIGA-Consciousness, University of Liege, Liege, Belgium.,Centre du Cerveau, University Hospital of Liege, Liege, Belgium
| | - Kathinka Evers
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden
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Evers K. Neurotechnological assessment of consciousness disorders: five ethical imperatives. DIALOGUES IN CLINICAL NEUROSCIENCE 2017. [PMID: 27489455 PMCID: PMC4969702 DOI: 10.31887/dcns.2016.18.2/kevers] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Disorders of consciousness (DOCs) cause great human suffering and material costs for society. Understanding of these disorders has advanced remarkably in recent years, but uncertainty remains with respect to the diagnostic criteria and standards of care. One of the most serious problems concerns misdiagnoses, their impact on medical decision-making, and on patients' well-being. Recent studies use neurotechnology to assess residual consciousness in DOC patients that traditional behavioral diagnostic criteria are unable to detect. The results show an urgent need to strengthen the development of new diagnostic tools and more refined diagnostic criteria. If residual consciousness may be inferred from robust and reproducible results from neurotechnological communication with DOC patients, this also raises ethical challenges. With reference to the moral notions of beneficence and fundamental rights, five ethical imperatives are here suggested in terms of diagnosis, communication, interpretation of subjective states, adaptation of living conditions, and care.
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Affiliation(s)
- Kathinka Evers
- Professor of Philosophy, Centre for Research Ethics & Bioethics (CRB), Uppsala University, Uppsala, Sweden
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