Neuroethics Research Unit, Department of Medicine and Department of Social and Preventive Medicine, Université de Montréal, Canada.
Can J Neurol Sci. 2010 Nov;37(6):758-68. doi: 10.1017/s0317167100051416.
The care of chronically unconscious patients raises vexing medical, ethical, and social questions concerning diagnosis, prognosis, communication with family members, and decision making, including the withdrawal of life support. We provide updates on major controversies surrounding disorders of consciousness. Issues such as withdrawal of artificial nutrition and hydration - which had been considered "settled" by many in the medical, legal and ethical communities - have resurfaced under the pressure of social groups and religious authorities. Some assumptions about the level of awareness and the prognosis of vegetative state and minimal conscious patients are questioned by advances in clinical care because of insights produced by neuroscience research techniques, particularly functional neuroimaging. Both the clinical and neuroscience dimensions of disorders of consciousness raise complex issues such as resource allocation and high levels of diagnostic inaccuracies (at least, for the vegetative state). We conclude by highlighting areas needing further research and collaboration.
慢性意识障碍患者的护理引发了一系列令人困扰的医学、伦理和社会问题，包括诊断、预后、与家属沟通以及决策，包括停止生命支持。我们提供了有关意识障碍相关主要争议的最新信息。一些问题，如停止人工营养和水合作用——这些问题在医疗、法律和伦理界的许多人看来已经“解决”——在社会团体和宗教当局的压力下再次浮现。由于神经科学研究技术（特别是功能神经影像学）所带来的见解，一些关于植物状态和最小意识状态患者的意识水平和预后的假设受到质疑。意识障碍的临床和神经科学两个方面都提出了复杂的问题，例如资源分配和高诊断准确率（至少对于植物状态）。最后，我们强调了需要进一步研究和合作的领域。
