The ethics of managing disorders of consciousness

Abstract

The ethical issues accrued from the study and management of severely brain-injured patients are varied and multi-faceted. The medical, legal and public controversies are partly shaped by how different people think about these issues and in many cases are culturally-dependent. An ethical framework needs to be shaped to guide clinicians and caregivers in terms of clinical diagnosis, prognosis, and medical management. In this chapter, we will give a brief overview of some ethical issues related to the concept of consciousness and the medical management of patients with disorders of consciousness such as comatose, vegetative/unresponsive and minimally conscious states that may be encountered in the intensive care setting. We will emphasize the problem of pain management and end-of-life decision-making.