Brain injury; Consciousness; Disorders of consciousness; Minimally conscious state; Neuroethics; Unresponsive wakefulness syndrome; Vegetative state; Health Policy; Health (social science); Issues, ethics and legal aspects
Abstract :
[en] 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.
Disciplines :
Human health sciences: Multidisciplinary, general & others
Author, co-author :
Farisco, Michele ; Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden. michele.farisco@crb.uu.se ; Science and Society Unit, Biogem, Biology and Molecular Genetics Research Institute, Ariano Irpino, AV, Italy. michele.farisco@crb.uu.se
Pennartz, Cyriel; 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
Annen, Jitka ; Université de Liège - ULiège > GIGA > GIGA Consciousness - Coma Science Group ; CHU Liège - Central University Hospital of Liege > Centre du Cerveau²
Cecconi, Benedetta ; Université de Liège - ULiège > GIGA > GIGA Consciousness - Coma Science Group ; CHU Liège - Central University Hospital of Liege > Centre du Cerveau²
Evers, Kathinka; Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden
Language :
English
Title :
Indicators and criteria of consciousness: ethical implications for the care of behaviourally unresponsive patients.
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