Lanoix Monique
Department of Philosophy and Religion, Appalachian State University, Boone, NC 28608-2104, USA.
Brain Inj. 2010;24(11):1336-42. doi: 10.3109/02699052.2010.504524.
Individuals suffering from severe disorders of consciousness (DOC) face a bleak prognosis and are susceptible to therapeutic neglect according to Fins. Because of the increasing occurrence of severe brain injury, some physicians and researchers take the study of DOC to be a moral imperative and perceive novel technologies, such as Deep Brain Stimulation (DBS), as offering potential therapeutic benefit.
This article examines the decisional process faced by proxy decision-makers for patients with severe DOC when confronted by novel treatments such as DBS.
If there is awareness in the literature that surrogate consent is complicated by the contingencies of severe brain injury such as disability and the possibility of long-term care, surrogate consent is often equated with substituted judgement and taking the best interests of the patient into account. However, for surrogates of patients with severe DOC, advocacy becomes a central component of the surrogate's role as there is no established standard of care for these patients in the post-acute phase. If participation in research is offered, the surrogate may perceive research participation as a way of providing benefits such as stimulation and some rehabilitation services for the patient.
Researchers need to be aware how the absence of a standard of care can shape surrogate choice.
根据芬斯的观点，患有严重意识障碍（DOC）的个体预后不佳，且易遭受治疗上的忽视。由于严重脑损伤的发生率不断上升，一些医生和研究人员认为对DOC的研究是一项道德义务，并将诸如深部脑刺激（DBS）等新技术视为具有潜在治疗益处。
本文探讨了严重DOC患者的代理决策者在面对诸如DBS等新疗法时所面临的决策过程。
如果文献中意识到替代同意因严重脑损伤的意外情况（如残疾和长期护理的可能性）而变得复杂，替代同意通常等同于替代判断并考虑患者的最大利益。然而，对于严重DOC患者的代理人而言，倡导成为代理人角色的核心组成部分，因为在急性期后这些患者没有既定的护理标准。如果提供参与研究的机会，代理人可能会将参与研究视为为患者提供诸如刺激和一些康复服务等益处的一种方式。
研究人员需要意识到护理标准的缺失会如何影响代理人的选择。
