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Wolf-Meyer M. Neurological disorders, affective bioethics, and the nervous system: reconsidering the Schiavo case from a materialist perspective. Med Humanit 2020; 46:166-175. [PMID: 30954935 DOI: 10.1136/medhum-2018-011568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 12/28/2018] [Accepted: 01/15/2019] [Indexed: 06/09/2023]
Abstract
This article proposes a novel approach to bioethics, referred to as "affective bioethics", which draws on traditions in anthropology, science and technology studies, disability studies, and Spinozist materialism. By focusing on the case of Michael and Terri Schiavo, in which Terri's personhood and subjectivity are challenged by dominant forms of neurological reductivism in the USA, this article suggests that approaching her condition as a set of relations with the people in her life and her socio-technical environment may have helped to develop new ways to conceptualise personhood and subjectivity moving beyond the view of her as a non-person. Drawing on Michael Schiavo's memoir of his legal battles, and Terri's diagnosis and care, this article shows how Terri's connections to the world disrupt American ideas about the isolatable individual as the basis for personhood and subjectivity. Attending to these interpersonal and socio-technical connections focuses bioethical attention on the worlds that individuals inhabit, and how those worlds might be designed to make more kinds of life livable and new forms of personhood and subjectivity possible.
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Guidry-Grimes L. Covert Consciousness and Covert Ethics. Perspect Biol Med 2020; 63:553-569. [PMID: 33416633 DOI: 10.1353/pbm.2020.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Rights Come to Mind: Brain Injury, Ethics, and the Struggle for Consciousness (2015) by Joseph J. Fins offers rich narratives of families and patients who experience disorders of consciousness in flawed health-care systems that are not clinically, structurally, financially, or ethically prepared to respond to the inherent complexities of these conditions. In 2018, only a few years after the publication of this book, the medical guidelines for these disorders officially changed with key publications in Neurology. Fins has called on bioethicists to respond to these significant developments, and this paper serves as a response to that call. This article offers a critical analysis of a couple of Fins's arguments. But it also emphasizes the importance of these developments and Fins's work for thinking through bedside and organizational ethics issues that arise in advocating for patients with disorders of consciousness.
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Napier S. The Minimally Conscious State, the Disability Bias, and the Moral Authority of Advance Directives. Int J Law Psychiatry 2019; 65:101333. [PMID: 29661479 DOI: 10.1016/j.ijlp.2018.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/16/2018] [Accepted: 03/20/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Stephen Napier
- SAC 108, Philosophy Department, 800 Lancaster Ave., Villanova, PA 19085, USA.
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Li Y, Luo X, Wan M, Li J, Wang H, Wei D, Feng H. The effectiveness of non-invasive brain stimulation on arousal and alertness in patients in coma or persistent vegetative state after traumatic brain injury: Protocol of systematic review and network meta-analysis. Medicine (Baltimore) 2018; 97:e12321. [PMID: 30212977 PMCID: PMC6155968 DOI: 10.1097/md.0000000000012321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 08/21/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Traumatic brain injury is a leading cause of death and disability worldwide. The survivors usually suffer from disorders of consciousness, especially coma state and persistent vegetative state. For these patients, there is no standard treatment for them, but non-invasive brain stimulations are considered as relatively more acceptable treatments. However, the knowledge regarding the relative effectiveness and the rank of the effectiveness of the non-invasive brain stimulations is limited. Thus, in this study, we aim to conduct a systematic review and network meta-analysis to evaluate the effect of non-invasive train stimulations on arousal and alertness in patients in a coma or persistent vegetative state after traumatic brain injury. METHODS AND ANALYSIS A comprehensive search strategy will be performed in the relevant databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wan Fang Data). The random or quasi-random controlled trails focusing on the effectiveness of the non-invasive brain stimulations will be included. The risk of bias for the included studies will be appraised using the Cochrane collaboration tool for assessing risk of bias. The standard pairwise meta-analysis and a Bayesian network meta-analysis will be conducted. ETHICS AND DISSEMINATION This research is a systematic review and network meta-analysis. Thus, there is no requirement of ethical approval and patient informed consent. PROSPERO REGISTRATION NUMBER CRD42018104945.
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Affiliation(s)
- Yabin Li
- Department of Neurological Rehabilitation, Rehabilitation Central Hospital of Gansu Province
| | - Xianggui Luo
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Miao Wan
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Jiao Li
- Department of Neurological Rehabilitation, Rehabilitation Central Hospital of Gansu Province
| | - Hongxia Wang
- Department of Neurological Rehabilitation, Rehabilitation Central Hospital of Gansu Province
| | - Dang Wei
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Haixia Feng
- Department of Neurological Rehabilitation, Rehabilitation Central Hospital of Gansu Province
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Steppacher I, Kissler J. The living dead? Perception of persons in the unresponsive wakefulness syndrome in Germany compared to the USA. BMC Psychol 2018; 6:5. [PMID: 29467036 PMCID: PMC5822482 DOI: 10.1186/s40359-018-0217-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/15/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The extent to which people ascribe mind to others has been shown to predict the extent to which human rights are conferred. Therefore, in the context of disorders of consciousness (DOC), mind ascription can influence end of life decisions. A previous US-American study indicated that participants ascribed even less mind to patients with unresponsive-wakefulness-syndrome (UWS) than to the dead. Results were explained in terms of implicit dualism and religious beliefs, as highly religious people ascribed least mind to UWS. Here, we addresses mind ascription to UWS patients in Germany. METHODS We investigate the perception of UWS patients in a large German sample (N = 910) and compare the results to the previous US data, addressing possible cultural differences. We further assess effects of medical expertise, age, gender, socio-economic status and subjective knowledge about UWS in the German sample. RESULTS Unlike the US sample, German participants did not perceive UWS patients as "more dead than dead", ascribing either equal (on 3 of 5 items) or more (on 2 items) mental abilities to UWS patients than to the dead. Likewise, an effect of implicit dualism was not replicated and German medically trained participants ascribed more capabilities to UWS patients than did a non-medical sample. Within the German sample, age, gender, religiosity and socio-economic status explained about 15% of the variability of mind ascription. Age and religiosity were individually significant predictors, younger and more religious people ascribing more mind. Gender had no effect. CONCLUSION Results are consistent with cross-cultural differences in the perception of UWS between Germany and the USA, Germans ascribing more mind to UWS patients. The German sample ascribed as much or more but not less mind to a UWS patient than to a deceased, although within group variance was large, calling for further research. Mind ascription is vital, because, in times of declining resources for healthcare systems, and an increasing legalization of euthanasia, public opinion will influence UWS patients' rights and whether 'the right to die' will be the only right conceded to them.
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Affiliation(s)
- Inga Steppacher
- Department of Psychology, University of Bielefeld, Universitätsstr. 25, 33615 Bielefeld, Germany
| | - Johanna Kissler
- Department of Psychology, University of Bielefeld, Universitätsstr. 25, 33615 Bielefeld, Germany
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Clinicians and the right to decide on withdrawal of treatment. BMJ 2017; 356:j15. [PMID: 28062396 DOI: 10.1136/bmj.j15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kondratyeva EA, Avdunina IA, Kondratyev AN, Ulitin AU, Ivanova NE, Petrova MV, Luginina EV, Grechko AV. [Vegetative State: Difficulty in Identifying Consciousness and Predicting Outcome]. Vestn Ross Akad Med Nauk 2016; 71:273-80. [PMID: 29297644 DOI: 10.15690/vramn728] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Article consists of literature review, authors experience of the application of neurovisualization and neurophysiological research methods to predict the recovery of consciousness in patients in vegetative state (VS). According to the literature data PET with FDG has higher sensitivity in the detection of signs of consciousness, then functional MRI (fMRI). The method fMRI allows assessing the functional activity of the brain in a state of rest and in response to stimulation with different modalities ― visual, auditory, etc (with the application of active and passive paradigm). A higher specificity in the detection of signs of consciousness have the methodology of fMRI with the active paradigm, at the same time, the absence of signs of consciousness according to the fMRI can not be charged as a basis for the conclusion of a poor prognosis in a particular patient. Neurophysiological tests (EEG, TMS, EP, etc) are more readily available and quite effective. Based on the literature analysis, the authors comes to the conclusion that neurovisualization and neurophysiological tests used in the prediction of the outcome of VS reflects the residual functional activity of different brain areas, in a context of diffuse brain damage, and the recovery of consciousness is usually combined with the restoring of the functional activity off the thalamocortical tracts, which activity, indirectly, is evaluated using these methods. In the authors' opinions, the main disadvantage in the interpretation of the is the lack of a common pathophysiological concept of the organization of brain functions in VS patients. The authors offer for the discussion their concept of stable pathological states of the brain, which is based on the works of Russian pathophysiologists.
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Abstract
This article is based on narrative research that focuses on corporeal experience during coma and during the rehabilitation process. Seventeen participants from different areas of Israel who had been in various kinds of coma states reveal what the corporeal experience of coma is. The participants are divided into three types of narrative protagonists--"dead-alive," "rational," and "emissaries." Each of the participants redefined the boundaries of the body, especially in cases when they spoke of experiences they did not understand as corporeal, for example, out-of-body experiences, near-death experiences, or experiences of being between the earthly and unearthly. Their struggle to find suitable words to tell their coma stories emphasizes these boundaries between experiencing and telling, which crossed the normative discursive border of the medical establishment and illustrates the ambiguous nature of human existence.
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Graham M, Weijer C, Peterson A, Naci L, Cruse D, Fernández-Espejo D, Gonzalez-Lara L, Owen AM. Acknowledging awareness: informing families of individual research results for patients in the vegetative state. J Med Ethics 2015; 41:534-8. [PMID: 25079068 PMCID: PMC4515978 DOI: 10.1136/medethics-2014-102078] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 07/03/2014] [Accepted: 07/15/2014] [Indexed: 05/25/2023]
Abstract
Recent findings in cognitive neuroscience have revealed that some patients previously diagnosed as being in a vegetative state may retain some degree of covert awareness. However, it is unclear whether such findings should be disclosed to the families of these patients. Concerns about the preservation of scientific validity, reliability of results and potential harms associated with disclosure suggest that individual research results should be disclosed only under certain conditions. In the following paper, we offer four criteria for the disclosure of individual research results. Because the results of functional neuroimaging studies to detect covert awareness in vegetative patients are scientifically valid, informative and reasonably reliable and have considerable potential benefit for the patient, researchers have an obligation to disclose such results to family members. Further work is needed to develop educational materials for families and to systematically study the impact of disclosure on the families themselves.
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Affiliation(s)
- Mackenzie Graham
- Department of Philosophy, Rotman Institute of Philosophy, Western University, London, Ontario, Canada
| | - Charles Weijer
- Department of Philosophy, Rotman Institute of Philosophy, Western University, London, Ontario, Canada
- Department of Psychology, The Brain and Mind Institute, Western University, London, Ontario, Canada
| | - Andrew Peterson
- Department of Philosophy, Rotman Institute of Philosophy, Western University, London, Ontario, Canada
- Department of Psychology, The Brain and Mind Institute, Western University, London, Ontario, Canada
| | - Lorina Naci
- Department of Psychology, The Brain and Mind Institute, Western University, London, Ontario, Canada
| | - Damian Cruse
- Department of Psychology, The Brain and Mind Institute, Western University, London, Ontario, Canada
| | - Davinia Fernández-Espejo
- Department of Psychology, The Brain and Mind Institute, Western University, London, Ontario, Canada
| | - Laura Gonzalez-Lara
- Department of Psychology, The Brain and Mind Institute, Western University, London, Ontario, Canada
| | - Adrian M Owen
- Department of Philosophy, Rotman Institute of Philosophy, Western University, London, Ontario, Canada
- Department of Psychology, The Brain and Mind Institute, Western University, London, Ontario, Canada
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Bagcchi S. Nurse who drove debate on euthanasia in India dies after 42 years in vegetative state. BMJ 2015; 350:h2806. [PMID: 26001841 DOI: 10.1136/bmj.h2806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Más-Sesé G, Sanchis-Pellicer MJ, Tormo-Micó E, Vicente-Más J, Vallalta-Morales M, Rueda-Gordillo D, Conejo-Alba A, Berbegal-Serra J, Martínez-Avilés P, Oltra-Masanet JA, Femenia-Pérez M. [Care for patients with altered states of consciousness in a hospital for chronic and long-stay patients]. Rev Neurol 2015; 60:249-256. [PMID: 25760719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Between 30% and 40% of patients with brain damage present alterations in their level of consciousness and, in some cases, altered states of consciousness: unresponsive wakefulness syndrome (UWS) or minimally conscious state (MCS). Recovery varies and survival is threatened by a number of complications. AIMS The purpose of this study is to present the working methodology used at the Hospital La Pedrera (HLP) for patients in UWS or MCS and to analyse the clinical characteristics of the patients attended to, their progress, and the functional and cognitive situation at the time of their discharge from hospital. PATIENTS AND METHODS The work consisted in a prospective descriptive study of patients seen at the HLP over the period 2009-2013, who had been diagnosed with UWS or MCS. RESULTS The HLP uses the case management method, offering integrated care dispensed by a multidisciplinary team. Patients are classified according to healthcare goals. Patients with UWS or MCS are included in the integrated care and adaptation programme. A total of 23 patients (86.9% males) were attended to, the mean age being 54.9 years. Aetiology: brain haemorrhage, 30.4%; anoxic encephalopathy, 26.6%; metabolic encephalopathy, 17.3%; and other causes, 17.3%. Altogether 73.9% were admitted in UWS and the rest in MCS. COURSE 43.4% improved their initial cognitive situation and 88.8% presented a situation of total dependence at the time of discharge. The most frequent complications were respiratory and urinary infections (53.6%). Death occurred in 65.2% of cases. CONCLUSIONS Medical attention in UWS or MCS is complex and requires multidisciplinary care. Almost half of the patients improved their cognitive situation, which justifies a proactive attitude that attempts to improve the quality of life of both patients and their families.
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Sattin D, Covelli V, Pagani M, Giovannetti AM, Raggi A, Meucci P, Cerniauskaite M, Quintas R, Schiavolin S, Leonardi M. Do diagnostic differences between vegetative state and minimally conscious state patients correspond to differences in functioning and disability profiles? Results from an observational multi-center study on patients with DOC. Eur J Phys Rehabil Med 2014; 50:309-321. [PMID: 24518146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Patients in vegetative (VS) and minimally conscious state (MCS) have different degrees of consciousness recovery but both display severe levels of disability. AIM To describe and compare VS and MCS patients' functioning and disability according to ICF model (International Classification of Functioning, Disability and Health). DESIGN Observational cross-sectional multi-center study involving sixty-nine Italian centers. SETTING Patients recruited in post-acute, long-term care facilities and at home in Italy. POPULATION Adult patients in VS and MCS. METHODS ICF Functioning profiles were completed and, for each ICF chapter and domain, extension and severity indexes were developed. Indexes have been compared between VS and MCS patients with Mann Whitney U test. Descriptive statistics have been applied to describe the most relevant categories that had a percentage of missing below 25% and that were reported as a problem by at least 50% of patients. RESULTS A total of 564 patients were enrolled: 396 in VS (mean age 56.8), 168 in MCS (mean age 54.2). Fifty-eight ICF categories were selected: of them, 24 were from Activity and Participation (A&P). Few differences between patients in VS and MCS were reported in Body Functions (BF), mostly referred to mental, sensory and digestive functions; among A&P, differences were found only in learning chapter. For VS patients less environmental barriers were reported than MCS patients. CONCLUSION Patients in VS and MCS have similar functioning and disability profiles and similar needs thus levels of care and assistance should not be different across the two conditions. CLINICAL REHABILITATION IMPACT An ICF-based methodology of data collection enables to describe VS and MCS patients' functioning and disability: this is helpful when rehabilitation programs based on the features of single patients with DOC need to be planned.
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Affiliation(s)
- D Sattin
- Neurology Public Health and Disability Unit Scientific Directorate Neurological Institute C. Besta IRCCS Foundation Milan, Italy -
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Abstract
Owen et al. (Brevia, 8 September 2006, p. 1402) claimed that a patient's brain activity revealed that she was consciously responding to commands despite being in a vegetative state. However, several alternative explanations were not eliminated. Specifically, the activity could reflect unconscious reactions to the last word in the command, not conscious decisions to respond. A refined experimental design could clarify these issues.
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Affiliation(s)
- Daniel L Greenberg
- Department of Psychology, University of California, Los Angeles, CA 90095, USA.
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Brukamp K. [Motor-independent communication by severely physically challenged patients: neuroscientific research results and patient autonomy]. Nervenarzt 2013; 84:1190-1195. [PMID: 24081276 DOI: 10.1007/s00115-013-3813-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Motor-independent communication is a novel diagnostic and therapeutic method that is currently in development in order to enable communication with severely physically challenged patients. Some patients with locked-in syndromes or with chronic disorders of consciousness are capable of modulating their brain activities to such a degree that the latter can be analyzed regarding communicative intentions with neuroscientific technologies, such as functional magnetic resonance imaging. Further scientific development and an increasing clinical use of motor-independent communication will aid in meeting essential quality standards for this method. In particular, the requirements need to be clarified under which the method may be utilized to support the patients' autonomy by enabling them to make their own decisions about therapeutic interventions. Communication mediated by technology promises to significantly improve the quality of life for severely physically challenged patients.
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Affiliation(s)
- K Brukamp
- Arbeitsbereich Geschichte der Medizin, Universitätsmedizin Rostock, Universität Rostock, Doberaner Str. 140, Raum 302/03, 18057, Rostock, Deutschland
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Lancioni GE, Singh NN, O'Reilly MF, Sigafoos J, Oliva D, Campodonico F, D'Amico F, Buonocunto F, Sacco V, Didden R. Post-coma persons emerging from a minimally conscious state with multiple disabilities make technology-aided phone contacts with relevant partners. Res Dev Disabil 2013; 34:3190-3196. [PMID: 23891723 DOI: 10.1016/j.ridd.2013.06.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 06/14/2013] [Indexed: 06/02/2023]
Abstract
Post-coma individuals emerging from a minimally conscious state with multiple disabilities may enjoy contact with relevant partners (e.g., family members and friends), but may not have easy access to them. These two single-case studies assessed whether those individuals could make contact with partners through computer-aided telephone technology and enjoy such contact. The technology involved a computer system with special software, a global system for mobile communication modem (GSM), and microswitch devices. In Study I, the computer system presented a 23-year-old man the names of the partners that he could contact, one at a time, automatically. Together with each partner's name, the system also presented the voice of the partner asking the man whether he wanted to call him or her. The man could (a) place a call to that partner by activating a camera-based microswitch through mouth movements or (b) bypass that partner and wait for the next one to be presented. In Study II, the system presented a 36-year-old man the partners' names only after he had activated his wobble microswitch with a hand movement. The man could place a call or bypass a partner as in Study I. The results showed that both men (a) were able to contact relevant partners through the technology, (b) seemed to enjoy their telephone-mediated communication contacts with the partners, and (c) showed preferences among the partners. Implications of the findings are discussed.
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Yu T, Lang S, Vogel D, Markl A, Müller F, Kotchoubey B. Patients with unresponsive wakefulness syndrome respond to the pain cries of other people. Neurology 2012; 80:345-52. [PMID: 23255830 DOI: 10.1212/wnl.0b013e31827f0846] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Tao Yu
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tuebingen, Germany
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Cruse D, Chennu S, Fernández-Espejo D, Payne WL, Young GB, Owen AM. Detecting awareness in the vegetative state: electroencephalographic evidence for attempted movements to command. PLoS One 2012; 7:e49933. [PMID: 23185489 PMCID: PMC3503880 DOI: 10.1371/journal.pone.0049933] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 10/18/2012] [Indexed: 12/02/2022] Open
Abstract
Patients in the Vegetative State (VS) do not produce overt motor behavior to command and are therefore considered to be unaware of themselves and of their environments. However, we recently showed that high-density electroencephalography (EEG) can be used to detect covert command-following in some VS patients. Due to its portability and inexpensiveness, EEG assessments of awareness have the potential to contribute to a standard clinical protocol, thus improving diagnostic accuracy. However, this technique requires refinement and optimization if it is to be used widely as a clinical tool. We asked a patient who had been repeatedly diagnosed as VS for 12-years to try to move his left and right hands, between periods of rest, while EEG was recorded from four scalp electrodes. We identified appropriate and statistically reliable modulations of sensorimotor beta rhythms following commands to try to move, which could be significantly classified at a single-trial level. These reliable effects indicate that the patient attempted to follow the commands, and was therefore aware, but was unable to execute an overtly discernable action. The cognitive demands of this novel task are lower than those used previously and, crucially, allow for awareness to be determined on the basis of a 20-minute EEG recording made with only four electrodes. This approach makes EEG assessments of awareness clinically viable, and therefore has potential for inclusion in a standard assessment of awareness in the VS.
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Affiliation(s)
- Damian Cruse
- Brain and Mind Institute, University of Western Ontario, London, Ontario, Canada.
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Lancioni GE, Singh NN, O'Reilly MF, Sigafoos J, Belardinelli MO, Buonocunto F, Sacco V, Navarro J, Lanzilotti C, De Tommaso M, Megna M, Badagliacca F. Promoting adaptive behavior in persons with acquired brain injury, extensive motor and communication disabilities, and consciousness disorders. Res Dev Disabil 2012; 33:1964-1974. [PMID: 22738766 DOI: 10.1016/j.ridd.2012.05.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Accepted: 05/29/2012] [Indexed: 06/01/2023]
Abstract
These two studies extended the evidence on the use of technology-based intervention packages to promote adaptive behavior in persons with acquired brain injury and multiple disabilities. Study I involved five participants in a minimally conscious state who were provided with intervention packages based on specific arrangements of optic, tilt, or pressure microswitches (linked to preferred environmental stimuli) and eyelid, toe and finger responses. Study II involved three participants who were emerging from a minimally conscious state and were provided with intervention packages based on computer presentations of stimulus options (i.e., preferred stimuli, functional caregiver's procedures, and non-preferred stimuli) and pressure microswitches to choose among them. Intervention data of Study I showed that the participants acquired relatively high levels of microswitch responding (thus engaging widely with preferred environmental stimuli) and kept that responding consistent except for one case. Intervention data of Study II showed that the participants were active in choosing among preferred stimuli and positive caregivers' procedures, but generally abstained from non-preferred stimuli. The results were discussed in terms of the successful use of fairly new/infrequent microswitch-response arrangements (Study I) and the profitable inclusion of functional caregiver's procedures among the options available to choice (Study II).
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Affiliation(s)
- Giulio E Lancioni
- Department of Neuroscience and Sense Organs, University of Bari, Italy.
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Kuehlmeyer K, Borasio GD, Jox RJ. How family caregivers' medical and moral assumptions influence decision making for patients in the vegetative state: a qualitative interview study. J Med Ethics 2012; 38:332-7. [PMID: 22375077 PMCID: PMC3359521 DOI: 10.1136/medethics-2011-100373] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 01/11/2012] [Accepted: 01/16/2012] [Indexed: 05/31/2023]
Abstract
BACKGROUND Decisions on limiting life-sustaining treatment for patients in the vegetative state (VS) are emotionally and morally challenging. In Germany, doctors have to discuss, together with the legal surrogate (often a family member), whether the proposed treatment is in accordance with the patient's will. However, it is unknown whether family members of the patient in the VS actually base their decisions on the patient's wishes. OBJECTIVE To examine the role of advance directives, orally expressed wishes, or the presumed will of patients in a VS for family caregivers' decisions on life-sustaining treatment. METHODS AND SAMPLE A qualitative interview study with 14 next of kin of patients in a VS in a long-term care setting was conducted; 13 participants were the patient's legal surrogates. Interviews were analysed according to qualitative content analysis. RESULTS The majority of family caregivers said that they were aware of aforementioned wishes of the patient that could be applied to the VS condition, but did not base their decisions primarily on these wishes. They gave three reasons for this: (a) the expectation of clinical improvement, (b) the caregivers' definition of life-sustaining treatments and (c) the moral obligation not to harm the patient. If the patient's wishes were not known or not revealed, the caregivers interpreted a will to live into the patient's survival and non-verbal behaviour. CONCLUSIONS Whether or not prior treatment wishes of patients in a VS are respected depends on their applicability, and also on the medical assumptions and moral attitudes of the surrogates. We recommend repeated communication, support for the caregivers and advance care planning.
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Affiliation(s)
- Katja Kuehlmeyer
- Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilians-University Munich, Lessingstr. 2, Munich D-80336, Germany.
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Scheichenberger S, Petz V. [Making the perceived accessible]. Pflege Z 2012; 65:275-277. [PMID: 22642198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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22
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Affiliation(s)
- Alison K Godbolt
- Department of Neuroscience/Rehabilitation Medicine, Neurodivision, University Hospital Uppsala, Uppsala, Sweden.
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Abstract
OBJECTIVES Family members of patients in a vegetative state have relatively high rates of anxiety and distress. It is important to recognize the problems faced by this population and apply psychological interventions to help them. This exploratory study describes the psychological stress experienced by family members of patients in a vegetative state. We discuss the effectiveness of a psychological crisis intervention directed at this population and offer suggestions for future clinical work. METHODS A total of 107 family members of patients in a vegetative state were included in the study. The intervention included four steps: acquisition of facts about each family, sharing their first thoughts concerning the event, assessment of their emotional reactions and developing their coping abilities. The Symptom Check List-90 was used to evaluate the psychological distress of the participants at baseline and one month after the psychological intervention. Differences between the Symptom Check List-90 scores at the baseline and follow-up evaluations were analyzed. RESULTS All participants in the study had significantly higher Symptom Check List-90 factor scores than the national norms at baseline. There were no significant differences between the intervention group and the control group at baseline. Most of the Symptom Check List-90 factor scores at the one-month follow-up evaluation were significantly lower than those at baseline for both groups; however, the intervention group improved significantly more than the control group on most subscales, including somatization, obsessive-compulsive behavior, depression, and anxiety. CONCLUSION The results of this study indicate that the four-step intervention method effectively improves the mental health of the family members who received this treatment and lessens the psychological symptoms of somatization, obsessive-compulsive behavior, depression and anxiety.
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Affiliation(s)
- Ya-Hong Li
- Department of Psychology, South-Central University for Nationalities, WuHan, People's Republic of China
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Abstract
Concepts, such as death, life and spirit cannot be known in their quintessential nature, but can be defined in accordance with their effects. In fact, those who think within the mode of pragmatism and Cartesian logic have ignored the metaphysical aspects of these terms. According to Islam, the entity that moves the body is named the soul. And the aliment of the soul is air. Cessation of breathing means leaving of the soul from the body. Those who agree on the diagnosis of brain death may not able to agree unanimously on the rules that lay down such diagnosis. That is to say, there are a heap of suspicions regarding the diagnosis of brain death, and these suspicions are on the increase. In fact, Islamic jurisprudence does not put provisions, decisions on suspicious grounds. By virtue of these facts, it can be asserted that brain death is not absolute death according to Islamic sources; for in the patients diagnosed with brain death the soul still has not abandoned the body. Therefore, these patients suffer in every operation performed on them.
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Affiliation(s)
- Ahmet Bedir
- Harran University, Faculty of Divinity, Department of Tafsîr (Islamic Exegesis), Sanliurfa, Turkey
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Schabus M, Pelikan C, Chwala-Schlegel N, Weilhart K, Roehm D, Donis J, Michitsch G, Pichler G, Klimesch W. Oscillatory brain activity in vegetative and minimally conscious state during a sentence comprehension task. Funct Neurol 2011; 26:31-36. [PMID: 21693086 PMCID: PMC3814508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Patients with altered states of consciousness continue to constitute a major challenge in terms of clinical assessment, treatment and daily management. Furthermore, the exploration of brain function in severely brain-damaged patients represents a unique lesional approach to the scientific study of consciousness. Electroencephalography is one means of identifying covert behaviour in the absence of motor activity in these critically ill patients. Here we focus on a language processing task which assesses whether vegetative (n=10) and minimally conscious state patients (n=4) (vs control subjects, n=14) understand semantic information on a sentence level ("The opposite of black is... white/yellow/nice"). Results indicate that only MCS but not VS patients show differential processing of unrelated ("nice") and antonym ("white") words in the form of parietal alpha (10-12Hz) event-related synchronization and desynchronization (ERS/ERD), respectively. Controls show a more typical pattern, characterized by alpha ERD in response to unrelated words and alpha ERS in response to antonyms.
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Affiliation(s)
- Manuel Schabus
- Laboratory for Sleep and Consciousness Research, Division of Physiological Psychology, University of Salzburg, Austria.
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Lotze M, Schertel K, Birbaumer N, Kotchoubey B. A long-term intensive behavioral treatment study in patients with persistent vegetative state or minimally conscious state. J Rehabil Med 2011; 43:230-6. [PMID: 21305239 DOI: 10.2340/16501977-0653] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Martin Lotze
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany.
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Lancioni GE, Bosco A, Belardinelli MO, Singh NN, O'Reilly MF, Sigafoos J. An overview of intervention options for promoting adaptive behavior of persons with acquired brain injury and minimally conscious state. Res Dev Disabil 2010; 31:1121-1134. [PMID: 20663643 DOI: 10.1016/j.ridd.2010.06.019] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 06/22/2010] [Indexed: 05/29/2023]
Abstract
This paper presents an overview of the studies directed at helping post-coma persons with minimally conscious state improve their adaptive behavior. Twenty-one studies were identified for the 2000-2010 period (i.e., a period in which an intense debate has occurred about diagnostic, rehabilitative, prognostic, and ethical issues concerning people with severe acquired brain injury). Three of the 21 studies involved transcortical magnetic or deep brain stimulation. Six studies focused on the provision of multisensory stimulation or music therapy. The remaining 12 studies involved the use of response-related (contingent) stimulation and assistive technology. The outcomes of the studies, which were generally reported as positive, were discussed in terms of (a) the size (quantitative relevance) of the changes obtained, (b) the credibility/reliability of the changes, in light of the methodological conditions of the studies, and (c) the level of engagement and interaction involvement of the participants. Relevant issues for future research were also examined.
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Racine E, Karczewska M, Seidler M, Amaram R, Illes J. How the public responded to the Schiavo controversy: evidence from letters to editors. J Med Ethics 2010; 36:571-573. [PMID: 20693482 DOI: 10.1136/jme.2010.037804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The history and genesis of major public clinical ethics controversies is intimately related to the publication of opinions and responses in media coverage. To provide a sample of public response in the media, this paper reports the results of a content analysis of letters to editors published in the four most prolific American newspapers for the Schiavo controversy. Opinions expressed in the letters sampled strongly supported the use of living wills and strongly condemned public attention to the case as well as political interventions. Letters tended to be against withdrawal of life support, proxy consent and associated procedures as well as against court decisions and legal procedures. In comparison with reports written by journalists, letters to editors contained fewer controversial claims about Schiavo''s neurological condition and behavioural repertoire but similar loaded language to describe withdrawal of life support. Distinct public discourses can be encountered in different stakeholders suggesting complex and extensive pluralism even within the media.
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Affiliation(s)
- Eric Racine
- Neuroethics Research Unit, Office 1535, IRCM, 110 Pine Avenue West, Montréal, Québec H2W 1R7, Canada.
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Sun F, Zhou G. Willful modulation of brain activity in disorders of consciousness. N Engl J Med 2010; 362:1937; author reply 1937-8. [PMID: 20496463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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30
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Ma Y, Fei Z, Qu Y. Willful modulation of brain activity in disorders of consciousness. N Engl J Med 2010; 362:1936-7; author reply 1937-8. [PMID: 20496461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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31
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Striano P, Zara F, Minetti C. Willful modulation of brain activity in disorders of consciousness. N Engl J Med 2010; 362:1937; author reply 1937-8. [PMID: 20496462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Vidmar R. [Improving quality of life]. Pflege Z 2010; 63:214-217. [PMID: 20426382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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34
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Nau JY. [When "vegetative state" is not really true]. Rev Med Suisse 2010; 6:418-419. [PMID: 20383974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Abstract
BACKGROUND The differential diagnosis of disorders of consciousness is challenging. The rate of misdiagnosis is approximately 40%, and new methods are required to complement bedside testing, particularly if the patient's capacity to show behavioral signs of awareness is diminished. METHODS At two major referral centers in Cambridge, United Kingdom, and Liege, Belgium, we performed a study involving 54 patients with disorders of consciousness. We used functional magnetic resonance imaging (MRI) to assess each patient's ability to generate willful, neuroanatomically specific, blood-oxygenation-level-dependent responses during two established mental-imagery tasks. A technique was then developed to determine whether such tasks could be used to communicate yes-or-no answers to simple questions. RESULTS Of the 54 patients enrolled in the study, 5 were able to willfully modulate their brain activity. In three of these patients, additional bedside testing revealed some sign of awareness, but in the other two patients, no voluntary behavior could be detected by means of clinical assessment. One patient was able to use our technique to answer yes or no to questions during functional MRI; however, it remained impossible to establish any form of communication at the bedside. CONCLUSIONS These results show that a small proportion of patients in a vegetative or minimally conscious state have brain activation reflecting some awareness and cognition. Careful clinical examination will result in reclassification of the state of consciousness in some of these patients. This technique may be useful in establishing basic communication with patients who appear to be unresponsive.
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Affiliation(s)
- Martin M Monti
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, United Kingdom
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38
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Carelli F. Persistent vegetative state. Br J Gen Pract 2010; 60:132. [PMID: 20132712 PMCID: PMC2814272 DOI: 10.3399/bjgp10x483256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Bressman JO, Reidler JS. Recent case developments in health law. "Willful modulation of brain activity in disorders of consciousness": legal and ethical ramifications. J Law Med Ethics 2010; 38:713-716. [PMID: 20931732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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40
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Abstract
The human brain is subjective and reflects the life of a being-in-the-world-with-others whose identity reflects that complex engaged reality. Human subjectivity is shaped and in-formed (formed by inner processes) that are adapted to the human life-world and embody meaning and the relatedness of a human being. Questions of identity relate to this complex and dynamic reality to reflect the fact that biology, human ecology, culture, and one's historic-political situation are inscribed in one's neural network and have configured its architecture so that it is a unique and irreplaceable phenomenon. So much is a human individual a relational being whose own understanding and ownership of his or her life is both situated and distinctive that neurophilosophical conceptions of identity and human activity that neglect these features of our being are quite inadequate to ground a robust neuroethics.
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41
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Affiliation(s)
- Stephen Lyng
- Department of Sociology, Carthage College, 2001 Alford Park Drive, Kenosha, WI 53140, USA.
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42
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Affiliation(s)
- S Van McCrary
- Clinical Ethics Consultation Service, Stony Brook University Medical Center, Stony Brook, NY 11794, USA.
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43
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Schütz A. [Chronically ill, a lifelong responsibility, regarded from 3 different perspectives. The quality of life aspect (2)]. Kinderkrankenschwester 2009; 28:320-322. [PMID: 19728467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Auguste Schütz
- Lehrerin für Gesundheitsberufe, Praxisbegleiterin für Basale Stimulation in der Pflege, Fraun- und Kinderklinik Linz, Linz.
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44
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Lavrijsen J, van den Bosch H, Koopmans R, van Weel C, Froeling P. Events and decision-making in the long-term care of Dutch nursing home patients in a vegetative state. Brain Inj 2009; 19:67-75. [PMID: 15762102 DOI: 10.1080/02699050410001720013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To clarify characteristics of long-term care and treatment of patients in a vegetative state. DESIGN Qualitative, descriptive study in a Dutch nursing home. METHODS Review of clinical records of patients in a vegetative state after acute brain damage between 1978-2002. RESULTS Five patients received intensive care of a multi-disciplinary team and showed considerable co-morbidity. There was no standard scenario for end-of-life decisions. Physicians play a more proactive role by evaluating the total medical treatment instead of withholding therapy in case of incidental complications. The families' attitude is a crucial factor in their ultimate decision. CONCLUSIONS There is no standard solution to alleviate the fate of patients in a vegetative state and their families. Withdrawing all medical treatment, including artificial nutrition and hydration, can be an acceptable scenario for letting the patient die. More research is needed to identify the factors that contribute to acceptance of the physician's decision by the family.
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Affiliation(s)
- Jan Lavrijsen
- 'De Zorgboog' Nursing Homes, Bakel, The Netherlands.
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Abstract
PRIMARY OBJECTIVE To challenge the Multi-Society Task Force's ruling that a persistent vegetative state (PVS) can be judged to be permanent for non traumatic brain injury after three months. METHOD We report the case of a 44-year-old man who had recovery of consciousness with persistent severe disability 19 months after a non-traumatic brain injury at least in part triggered and maintained by intrathecal baclofen administration. RESULT This unexpected and late recovery of consciousness raises an interesting hypothesis of possible effects of partially regained spinal cord outputs on reactivation of cognition. CONCLUSION Considering that several ethical, legal, and socio-economic issues have been raised about the opportunity of withdrawing treatment and life support in patients with PVS the report of this case might add further documentation to the ongoing debate.
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Affiliation(s)
- Marco Sarà
- Istituto San Raffaele-Tosinvest Sanità. Post-Coma Intensive and Rehabilitation Care Unit, Cassino.
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46
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Abstract
PRIMARY OBJECTIVE Examining the evidence from contrasting epistemological sources a case is made for the use of music as an assessment medium with patients in low awareness states. Profound brain damage can result in long-term states of altered consciousness such as vegetative and minimally conscious states. Differential diagnosis with this population is immensely complex requiring diverse approaches. Neuroimaging alone is not, as yet, sufficient to establish diagnosis in this population and must be supplemented by repeated behavioural observation methods from a skilled and diverse treatment team, as there are enormous medico-legal and ethical implications. Evidence from research in neuroimaging and the behavioural health sciences indicates that auditory stimulation can reveal residual functioning and elicit optimal behaviours in such patients, particularly when the stimulation has emotional significance. MAIN OUTCOMES AND RESULTS Behavioural assessment is complicated by limbic behaviours which can be misinterpreted as purposeful emotional responses. A case vignette using music therapy in a complex case illustrates such complications. CONCLUSIONS Given the evidence for residual auditory functioning in patients in low awareness states, music is recommended as a medium for assessment. However, professionals involved in diagnosis must take caution against misinterpreting limbic responses and attributing greater meaning to such behaviours.
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Affiliation(s)
- Wendy L Magee
- Institute of Neuropalliative Rehabilitation, London, UK.
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47
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Kaser B. [Chronically ill, a lifelong responsibility, regarded from 3 different perspectives. Friedmann family and environment relevant nursing (1)]. Kinderkrankenschwester 2009; 28:278-280. [PMID: 19731757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Birgit Kaser
- Gesundheits- und Krankenpflege Frauen- und Kinderklinik Linz, Linz.
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Reinoso Suárez F. [Vegetative condition (state) and conscious thought. Reflections scientific neuro and ethics]. An R Acad Nac Med (Madr) 2009; 126:345-356. [PMID: 20432676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Thirty years ago, the study of the brain lesions of a patient who had remained in a coma for eight years, together with my experience on the degree of wakefulness of animals with similar lesions, compelled me to reflecting on the level of consciousness that our patient had. Recent findings from functional magnetic resonance image, that have shown aspects of speech perception, emotional processing, language comprehension and even conscious awareness might be retained in patients who behaviourally meet all of the criteria that define the vegetative state, have allowed me to make new neuroscientists and ethical reflections.
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Wilkinson D, Kahane G, Savulescu J. "Neglected personhood" and neglected questions: remarks on the moral significance of consciousness. Am J Bioeth 2008; 8:31-33. [PMID: 18853381 DOI: 10.1080/15265160802412486] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Dominic Wilkinson
- University of Oxford, Oxford Uehiro Centre for Practical Ethics, Littlegate House, Oxford, UK.
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50
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Affiliation(s)
- Monique Lanoix
- Novel Tech Ethics, Dalhousie University, Halifax, Nova Scotia, Canada.
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