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Indicators and criteria of consciousness for behaviourally unresponsive patients

2022-03-23

Identifying and quantifying residual consciousness in patients with disorders of consciousness is notoriously challenging but increasingly urgent. There is a high rate of misdiagnosis among patients suffering from these disorders, particularly between vegetative states/unresponsive wakefulness syndrome and minimally conscious states. A recent BMC Medical Ethics publication explores how operational indicators previously introduced to assess consciousness in non-human animals and artificial intelligence can be relevant and have an ethical impact on the diagnosis and care of patients with disorders of consciousness. 

When observing the behaviour or cognitive performance of a subject, indicators of consciousness are specific capacities that can facilitate an assessment of that subject’s level of consciousness. The proposed indicators of consciousness go beyond verbal and behavioural criteria to determine a subject’s level of consciousness, which is why the authors argue the indicators are also relevant to patients who are not able to present evidence of consciousness in these ways. This means there are specific ethical implications to consider, as the indicators being forth new theoretical perspectives that can impact clinical practice as they inspire new strategies for operationalising and quantifying relevant cognitive and cerebral functions.

“There is an urgent need to limit misdiagnoses. To make this possible, we need a gold standard for detecting consciousness and diagnosing its disorders, and we need to refine the taxonomy of disorders of consciousness. What our indicators of consciousness offer is a starting point to advance in all these directions,” says Michele Farisco, post-doc researcher at the Centre for Research Ethics and Bioethics of Uppsala University and one of the authors of the paper.

By Anna Holm

Farisco M, Pennartz C, Annen J, Cecconi B, & Evers K. Indicators and criteria of consciousness: ethical implications for the care of behaviourally unresponsive patients. BMC Medical Ethics, 2022:23;30. DOI: 10.1186/s12910-022-00770-3