Ethics and the 2018 Practice Guideline on Disorders of Consciousness: A Framework for Responsible Implementation

Overview

Journal Neurology

Specialty Neurology

Date 2022 Mar 12

PMID 35277446

Authors

Andrew Peterson

Michael J Young

Joseph J Fins

Affiliations

Soon will be listed here.

Abstract

The 2018 practice guideline on disorders of consciousness marks an important turning point in the care of patients with severe brain injury. As clinicians and health systems implement the guideline in practice, several ethical challenges will arise in assessing the benefits, harms, feasibility, and cost of recommended interventions. We provide guidance for clinicians when interpreting these recommendations and call on professional societies to develop an ethical framework to complement the guideline as it is implemented in clinical practice.

Citing Articles

Ethically Translating Advanced Neurotechnologies for Disorders of Consciousness: A Survey of Clinicians' Perspectives.

Bhardwaj T, Edlow B, Young M Neurocrit Care. 2024; .

PMID: 39477905 DOI: 10.1007/s12028-024-02147-3.

Clinical Implementation of fMRI and EEG to Detect Cognitive Motor Dissociation: Lessons Learned in an Acute Care Hospital.

Bodien Y, Fecchio M, Freeman H, Sanders W, Meydan A, Lawrence P Neurol Clin Pract. 2024; 15(1):e200390.

PMID: 39473967 PMC: 11515113. DOI: 10.1212/CPJ.0000000000200390.

Effectiveness of coma arousal therapy on patients with disorders of consciousness - A systematic review and meta-analysis.

Kumar S, Agarwal N, Sanal T Brain Circ. 2024; 10(2):119-133.

PMID: 39036297 PMC: 11259325. DOI: 10.4103/bc.bc_112_23.

Limitation of life sustaining therapy in disorders of consciousness: ethics and practice.

Lissak I, Young M Brain. 2024; 147(7):2274-2288.

PMID: 38387081 PMC: 11224617. DOI: 10.1093/brain/awae060.

Characterizing coma in large vessel occlusion stroke.

Young M, Awad A, Andreev A, Bonkhoff A, Schirmer M, Dmytriw A J Neurol. 2024; 271(5):2658-2661.

PMID: 38366071 PMC: 11889655. DOI: 10.1007/s00415-024-12199-2.

References

Giacino J, Bodien Y, Zuckerman D, Henderson J, Schiff N, Fins J . Empiricism and Rights Justify the Allocation of Health Care Resources to Persons with Disorders of Consciousness. AJOB Neurosci. 2021; 12(2-3):169-171. DOI: 10.1080/21507740.2021.1904055. View

Blumenthal-Barby J, Krieger H . Cognitive biases and heuristics in medical decision making: a critical review using a systematic search strategy. Med Decis Making. 2014; 35(4):539-57. DOI: 10.1177/0272989X14547740. View

Malenka D, Baron J, Johansen S, Wahrenberger J, Ross J . The framing effect of relative and absolute risk. J Gen Intern Med. 1993; 8(10):543-8. DOI: 10.1007/BF02599636. View

Fins J, Bernat J . Ethical, palliative, and policy considerations in disorders of consciousness. Neurology. 2018; 91(10):471-475. DOI: 10.1212/WNL.0000000000005927. View

Weijer C, Singer P, Dickens B, Workman S . Bioethics for clinicians: 16. Dealing with demands for inappropriate treatment. CMAJ. 1998; 159(7):817-21. PMC: 1232742. View

Davidson J, Powers K, Hedayat K, Tieszen M, Kon A, Shepard E . Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004-2005. Crit Care Med. 2007; 35(2):605-22. DOI: 10.1097/01.CCM.0000254067.14607.EB. View

Peterson A, Webster F, Gonzalez-Lara L, Munce S, Owen A, Weijer C . Caregiver reactions to neuroimaging evidence of covert consciousness in patients with severe brain injury: a qualitative interview study. BMC Med Ethics. 2021; 22(1):105. PMC: 8320067. DOI: 10.1186/s12910-021-00674-8. View

Peterson A, Owen A, Karlawish J . Alive inside. Bioethics. 2019; 34(3):295-305. PMC: 7065158. DOI: 10.1111/bioe.12678. View

Sethi N . Reader response: Ethical, palliative, and policy considerations in disorders of consciousness. Neurology. 2019; 92(20):973-974. DOI: 10.1212/WNL.0000000000007514. View

10.

Wilson J, Shinall Jr M, Leath T, Wang L, Harrell Jr F, Wilson L . Worse Than Death: Survey of Public Perceptions of Disability Outcomes After Hypothetical Traumatic Brain Injury. Ann Surg. 2020; 273(3):500-506. PMC: 8558681. DOI: 10.1097/SLA.0000000000003389. View

11.

White D, Ernecoff N, Buddadhumaruk P, Hong S, Weissfeld L, Curtis J . Prevalence of and Factors Related to Discordance About Prognosis Between Physicians and Surrogate Decision Makers of Critically Ill Patients. JAMA. 2016; 315(19):2086-94. DOI: 10.1001/jama.2016.5351. View

12.

Schneiderman L, Jecker N, Jonsen A . Medical futility: its meaning and ethical implications. Ann Intern Med. 1990; 112(12):949-54. DOI: 10.7326/0003-4819-112-12-949. View

13.

Jones K, Quinn T, Mazor K, Muehlschlegel S . Prognostic Uncertainty in Critically Ill Patients with Traumatic Brain Injury: A Multicenter Qualitative Study. Neurocrit Care. 2021; 35(2):311-321. DOI: 10.1007/s12028-021-01230-3. View

14.

Young M, Bodien Y, Giacino J, Fins J, Truog R, Hochberg L . The neuroethics of disorders of consciousness: a brief history of evolving ideas. Brain. 2021; 144(11):3291-3310. PMC: 8883802. DOI: 10.1093/brain/awab290. View

15.

Armstrong M, Gronseth G . Approach to assessing and using clinical practice guidelines. Neurol Clin Pract. 2018; 8(1):58-61. PMC: 5839679. DOI: 10.1212/CPJ.0000000000000417. View

16.

Graham M . Domains of Well-Being in Minimally Conscious Patients: Illuminating a Persistent Problem. AJOB Neurosci. 2018; 9(2):128-130. PMC: 5989155. DOI: 10.1080/21507740.2018.1460415. View

17.

Almashat S, Ayotte B, Edelstein B, Margrett J . Framing effect debiasing in medical decision making. Patient Educ Couns. 2008; 71(1):102-7. DOI: 10.1016/j.pec.2007.11.004. View

18.

Hammond F, Katta-Charles S, Russell M, Zafonte R, Claassen J, Wagner A . Research Needs for Prognostic Modeling and Trajectory Analysis in Patients with Disorders of Consciousness. Neurocrit Care. 2021; 35(Suppl 1):55-67. PMC: 8848858. DOI: 10.1007/s12028-021-01289-y. View

19.

Edlow B, Claassen J, Schiff N, Greer D . Recovery from disorders of consciousness: mechanisms, prognosis and emerging therapies. Nat Rev Neurol. 2020; 17(3):135-156. PMC: 7734616. DOI: 10.1038/s41582-020-00428-x. View

20.

Peterson A, Aas S, Wasserman D . What Justifies the Allocation of Health Care Resources to Patients with Disorders of Consciousness?. AJOB Neurosci. 2021; 12(2-3):127-139. DOI: 10.1080/21507740.2021.1896594. View