Disorders of Consciousness in Clinical Practice

Abstract

“Disorders of Consciousness in Clinical Practice” considers the ethical, legal, and policy considerations of working with patients and families with severe brain injury. Topics include professional obligations to patients with disorders of consciousness and the ethical implications of coma, brain death and the vegetative and minimally conscious state as well as their diagnostic classification based on behavioral and neuroimaging assessment. The normative challenge of covert consciousness is considered. Clinical, ethical and communication strategies for working with patients with impaired decision-making capacity and their families and surrogates are presented along a typical trajectory of care from initial presentation, intensive care, and discharge to rehabilitation and/or long-term care. End-of-life care, neuropalliation, and bereavement are also discussed as are ancillary care obligations to this marginalized and vulnerable population. Broader policy needs such as access to care is discussed in the context of civil and disability rights.