{"id":1329,"date":"2011-11-10T00:01:55","date_gmt":"2011-11-09T23:01:55","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=1329"},"modified":"2011-11-10T09:17:03","modified_gmt":"2011-11-10T08:17:03","slug":"discovering-consciousness-in-the-%e2%80%9cpermanently-unconscious%e2%80%9d-what-should-we-do","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2011\/11\/10\/discovering-consciousness-in-the-%e2%80%9cpermanently-unconscious%e2%80%9d-what-should-we-do\/","title":{"rendered":"Discovering Consciousness in the \u201cPermanently Unconscious\u201d: What Should We Do?"},"content":{"rendered":"

Comment on \u201cBedside detection of awareness in the vegetative state: a cohort study\u201d by Damian Cruse, Srivas Chennu, Camille Chatelle, Tristan A Bekinschtein, Davinia Fern\u00e1ndez-Espejo, John D Pickard, Steven Laureys, Adrian M Owen<\/p>\n

Published in The Lancet<\/em>, online Nov 10.<\/p>\n

Cruse and colleagues founds evidence of some kind of consciousness in 3 out of 16 patients diagnosed as being permanently unconscious. They used an EEG machine, capable of being deployed at the bedside. Is this good news?<\/p>\n

This important scientific study raises more ethical questions than it answers. \u00a0People who are deeply unconscious don\u2019t suffer. \u00a0But are these patients suffering? \u00a0How bad is their life? \u00a0Do they want to continue in that state? \u00a0If they could express a desire, should it be respected?<\/p>\n

The important ethical question is not: are they conscious? \u00a0It is: in what way<\/em> are they conscious? \u00a0Ethically, we need answers to that. \u00a0Life prolonging treatment has been and legally can be withdrawn from patients who are permanently unconsciousness. \u00a0We need guidelines for when life-prolonging treatment should be withdrawn in these minimally conscious states. \u00a0Paradoxically, it could be worse for some than being permanently unconscious. \u00a0And in countries like the Netherlands, we need guidelines on whether and when active euthanasia should be performed. \u00a0For some of these patients, consciousness could be the experience of a living hell.<\/p>\n

Previous research by some of these authors shows importantly that some patients who are \u201clocked-in\u201d \u2013 who are clearly conscious and can communicated but cannot move at all \u2013 find their lives worth living. \u00a0Even this finding would not settle what should be done. \u00a0What makes each person\u2019s own living hell is a matter for that person. \u00a0It is subjective. \u00a0And we can adapt to terrible disability. \u00a0That is important for all of us to know. \u00a0But it does not change the rights of individuals to make what they will of their lives, including choosing the conditions under which and the time to end them. \u00a0One possible solution to these issues is to form a living will about what should happen to you, if you were to be in such a state (see: http:\/\/blog.practicalethics.ox.ac.uk\/2011\/02\/ethical-lessons-from-locked-in-syndrome-what-is-a-living-hell\/)<\/p>\n

Such cases also raise ethical issues of futility and the appropriate allocation of limited resources on patients with severely impaired quality of life. \u00a0That is, they raise questions of distributive justice. \u00a0Even if such patients are minimally conscious, is it fair and just to use public resources to keep them alive for many years? \u00a0Very poor quality of life has been used as ground for withholding or withdrawing medical treatment.<\/p>\n

Science is invaluable in discovering what the world, including ourselves, is like. \u00a0But it can never alone tell us what we should do. \u00a0The big question \u2013 how such patients should be treated \u2013 remains as open as ever. \u00a0We need more science to find out what the life of such patients is like. \u00a0But we also need ethics to decide what we do when we discover that.<\/p>\n

Further Reading<\/strong><\/p>\n

Savulescu, J. and Kahane, G. (2009). \u2018Brain-Damaged Patients and the Moral Significance of Consciousness\u2019. Journal of Medicine and Philosophy. 33:\u00a0 1-21. \u00a0doi:10.1093\/jmp\/jhn038<\/p>\n

Skene, L., Wilkinson, D., Kahane, G., and Savulescu, J. (2009). \u2018Neuroimaging and the Withdrawal of Life-Sustaining Treatment from Patients in Vegetative State\u2019. Medical Law Review. 17: 245-261.\u00a0 doi: 10.1093\/medlaw\/fwp 002\u00a0\u00a0 ISSN: 1464-3790<\/p>\n

Wilkinson, D., Kahane, G., Horne, M., and Savulescu, J., (2009). \u2018Functional Neuroimaging and Withdrawal of Life-sustaining Treatment from Vegetative Patients\u2019. Journal of Medical Ethics. 35: 508-511.<\/p>\n

Wilkinson, D., Kahane, G., and Savulescu, J., (2008). \u2018Neglected Personhood\u2019 and Neglected Questions: Remarks on the Moral Significance of Consciousness\u2019, American Journal of Bioethics. 8:9 31- 33.<\/p>\n

For more on distributive justice and limitation of life-prolonging medical treatment, see:\u00a0Wilkinson, D. and Savulescu, J. (2011) \u2018Knowing when to stop: futility in the ICU\u2019.\u00a0 Current Opinion in Anaesthiology April 2011 Vol: 24 (2) pp 160-165<\/p>\n

Savulescu, J. (2001). \u2018Resources, Down Syndrome and Cardiac Surgery\u2019. British Medical Journal.322:875-6.<\/p>\n

Julian Savulescu<\/p>\n

Director<\/p>\n

Oxford Centre for Neuroethics<\/p>\n

Editor<\/p>\n

Journal of Medical Ethics<\/p>\n

jsavulescu@gmail.com<\/a><\/p>\n

Contact: 01865286888<\/p>\n

(Cross-posted at Practical Ethics<\/a>)<\/p>\n

<\/p>\n","protected":false},"excerpt":{"rendered":"

Comment on \u201cBedside detection of awareness in the vegetative state: a cohort study\u201d by Damian Cruse, Srivas Chennu, Camille Chatelle, Tristan A Bekinschtein, Davinia Fern\u00e1ndez-Espejo, John D Pickard, Steven Laureys, Adrian M Owen Published in The Lancet, online Nov 10. Cruse and colleagues founds evidence of some kind of consciousness in 3 out of 16 […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1240,1542,511,591,328,577],"tags":[],"class_list":["post-1329","post","type-post","status-publish","format-standard","hentry","category-blogosphere","category-in-the-journals","category-in-the-news","category-life-and-death","category-philosophy","category-resource"],"yoast_head":"\nDiscovering Consciousness in the \u201cPermanently Unconscious\u201d: What Should We Do? - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2011\/11\/10\/discovering-consciousness-in-the-\u201cpermanently-unconscious\u201d-what-should-we-do\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Discovering Consciousness in the \u201cPermanently Unconscious\u201d: What Should We Do? - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"Comment on \u201cBedside detection of awareness in the vegetative state: a cohort study\u201d by Damian Cruse, Srivas Chennu, Camille Chatelle, Tristan A Bekinschtein, Davinia Fern\u00e1ndez-Espejo, John D Pickard, Steven Laureys, Adrian M Owen Published in The Lancet, online Nov 10. 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