Abstract
This article considers recent developments in neurotechnology and their potential to either mitigate or exacerbate the uncertainty of diagnosis and prognosis of DoCs, as well as the potential impact of replacing the diagnosis of vegetative state with unresponsive wakefulness syndrome. The main reasons for abolishing the term “vegetative state” are (1) the unacceptably high misclassification rate of patients with covert awareness, (2) the undesirable prescriptive connotations of the term, and (3) the unwarranted prognostic connotations. While improving prognosis and diagnosis may help surrogates as they face decisions concerning treatment, more accurate diagnosis and prognosis will not by themselves provide decisive answers. Significant diagnostic and prognostic uncertainties are likely to persist and may in fact be ineliminable. We argue that this uncertainty has to be acknowledged, communicated, and factored together with patient values, desires, and preferences in ethically complex, value-laden decisions about the treatment of brain-injured patients.
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