Editors' note: Ethical, palliative, and policy considerations in disorders of consciousness

Abstract

In “Ethical, palliative, and policy considerations in disorders of consciousness,” a complement to the American Academy of Neurology guideline on disorders of consciousness, authors Fins and Bernat reviewed (1) the nomenclature of disorders of consciousness, (2) the responsibilities that clinicians have to both patients and their families, and (3) the resources required and barriers to provision of care to patients with disorders of consciousness. Authors Fins and Bernat objected to the Guideline's use of the term “unresponsive wakefulness syndrome” because it relies on the bedside examination of consciousness while failing to allow for the possibility of covert consciousness detected only with functional neuroimaging. Dr. Sethi shares his reservations with this term, but his rationale differs, as he believes it could falsely suggest the possibility for improvement. He also voices concern that both a country's income level and a hospital's size could affect ability to implement this guideline. Authors Fins and Bernat respond that all patients with disorders of consciousness deserve consideration of rehabilitation and that rehabilitation may ultimately decrease longitudinal costs by leading to improvements in functional status, but prospective studies are needed. In “Ethical, palliative, and policy considerations in disorders of consciousness,” a complement to the American Academy of Neurology guideline on disorders of consciousness, authors Fins and Bernat reviewed (1) the nomenclature of disorders of consciousness, (2) the responsibilities that clinicians have to both patients and their families, and (3) the resources required and barriers to provision of care to patients with disorders of consciousness. Authors Fins and Bernat objected to the Guideline's use of the term “unresponsive wakefulness syndrome” because it relies on the bedside examination of consciousness while failing to allow for the possibility of covert consciousness detected only with functional neuroimaging. Dr. Sethi shares his reservations with this term, but his rationale differs, as he believes it could falsely suggest the possibility for improvement. He also voices concern that both a country's income level and a hospital's size could affect ability to implement this guideline. Authors Fins and Bernat respond that all patients with disorders of consciousness deserve consideration of rehabilitation and that rehabilitation may ultimately decrease longitudinal costs by leading to improvements in functional status, but prospective studies are needed.