The minimally conscious state: Definition and diagnostic criteria
Joseph JFins, New York Presbyterian Hospital-Weill Cornell Center New York[email protected]
Nicholas D. Schiff
Submitted June 24, 2002
The response engendered by the proposed criteria for the minimally
conscious state by Giacino et. al. is at once predictable and paradoxical.
[1, 2, 3] It is predictable in voicing concern that a new diagnostic
category could be used to undermine the care of the severely disabled.
Opponents contend that in the absence of an evidence base for these
criteria, the consensus model used to generate these guidelines represents
the consolidation of an ideological stance about the worth of these
individuals. But is also paradoxical. This categorization could be a
helpful tool in better understanding the continuum of brain states and
designing research and therapies to improve and augment cognitive
function. [1]
By further distinguishing those in PVS from those who we suspect have
elements of consciousness; we can collectively make a stronger
distributive justice claim for enhanced services and more research to
address the needs of patients and families with brain injury. Practically,
this regard should translate into better diagnostic precision. The
staggering public health need posed by traumatic brain injury, coupled
with society's marginalization of the disabled, makes this an ethical
imperative as medicine seeks to provide the benefits of science to these
historically under-served individuals. [1] In this we disagree with Dr.
Shewmon’s assertion that, “there is no clinical or research need for, and
strong reasons against, inventing a new diagnostic ‘entity’ that
inherently cannot not be meaningfully demarcated from ‘severe disability.”
While the concerns of Ms. Coleman are understandable and laudable, it
would be more productive if she broadened her advocacy to bring
therapeutic or palliative care advances to those with brain injury.
Similarly, researchers and clinicians should seek out the diverse views of
the disability community. While we applaud advocacy for the disabled, it
is important that it does not pre-empt the prerogative of properly
authorized surrogates to make decisions to withdraw life-sustaining
therapies in accord with the patient’s previously expressed preferences.
References:
1. Giacino JT, Ashwal S, Childs N et al. The minimally conscious
state: Definition and diagnostic criteria. Neurology 2002;58:349-353.
2. Coleman D. The minimally conscious state: Definition and
diagnostic criteria. Neurology 2002;58:506-507.
3. Shewmon DA. The minimally conscious state: Definition and
diagnostic criteria. Neurology 2002;58:506-507.
4. Fins JJ. A proposed ethical framework for interventional cognitive
neuroscience: A consideration of deep brain stimulation in impaired
consciousness. Neurological Research 2000;22:273-278.
The response engendered by the proposed criteria for the minimally conscious state by Giacino et. al. is at once predictable and paradoxical. [1, 2, 3] It is predictable in voicing concern that a new diagnostic category could be used to undermine the care of the severely disabled. Opponents contend that in the absence of an evidence base for these criteria, the consensus model used to generate these guidelines represents the consolidation of an ideological stance about the worth of these individuals. But is also paradoxical. This categorization could be a helpful tool in better understanding the continuum of brain states and designing research and therapies to improve and augment cognitive function. [1]
By further distinguishing those in PVS from those who we suspect have elements of consciousness; we can collectively make a stronger distributive justice claim for enhanced services and more research to address the needs of patients and families with brain injury. Practically, this regard should translate into better diagnostic precision. The staggering public health need posed by traumatic brain injury, coupled with society's marginalization of the disabled, makes this an ethical imperative as medicine seeks to provide the benefits of science to these historically under-served individuals. [1] In this we disagree with Dr. Shewmon’s assertion that, “there is no clinical or research need for, and strong reasons against, inventing a new diagnostic ‘entity’ that inherently cannot not be meaningfully demarcated from ‘severe disability.”
While the concerns of Ms. Coleman are understandable and laudable, it would be more productive if she broadened her advocacy to bring therapeutic or palliative care advances to those with brain injury. Similarly, researchers and clinicians should seek out the diverse views of the disability community. While we applaud advocacy for the disabled, it is important that it does not pre-empt the prerogative of properly authorized surrogates to make decisions to withdraw life-sustaining therapies in accord with the patient’s previously expressed preferences.
References:
1. Giacino JT, Ashwal S, Childs N et al. The minimally conscious state: Definition and diagnostic criteria. Neurology 2002;58:349-353.
2. Coleman D. The minimally conscious state: Definition and diagnostic criteria. Neurology 2002;58:506-507.
3. Shewmon DA. The minimally conscious state: Definition and diagnostic criteria. Neurology 2002;58:506-507.
4. Fins JJ. A proposed ethical framework for interventional cognitive neuroscience: A consideration of deep brain stimulation in impaired consciousness. Neurological Research 2000;22:273-278.