In my opinion, this is the most accurate, concise, easy-to-understand description of what is happening in MCS (and EHS) according to what the science is telling us.
In this article, I consider whether the advance directive of a person in minimally conscious state ought to be adhered to when its prescriptions conflict with her current wishes. I argue that an advance directive can have moral significance after its issuer has succumbed to minimally conscious state. I also defend the view that the patient can still have a significant degree of autonomy. Consequently, I conclude that her advance directive ought not to be applied. Then I briefly assess whether considerations pertaining to respecting the patient's autonomy could still require obedience to the desire expressed in her advance directive and arrive at a negative answer.
Scientists have been able to reach into the mind of a brain-damaged man and communicate with his thoughts. The research, carried out in the UK and Belgium, involved a new brain scanning method. Awareness was detected in three other patients previously diagnosed as being in a vegetative state. The study in the New England Journal of Medicine shows that scans can detect signs of awareness in patients thought to be closed off from the world. Patients in a vegetative state are awake, not in a coma, but have no awareness because of severe brain damage. The scientists used functional magnetic resonance imaging (fMRI) which shows brain activity in real time.
Brain imaging has allowed a man who was previously considered unconscious to answer a series of yes-or-no questions. The study, published this week in the New England Journal of Medicine1, challenges clinicians' definition of consciousness and provides an unprecedented opportunity to communicate with those who show no outward signs of awareness.
Background The differential diagnosis of disorders of consciousness is challenging. The rate of misdiagnosis is approximately 40%, and new methods are required to complement bedside testing, particularly if the patient's capacity to show behavioral signs of awareness is diminished. Conclusions These results show that a small proportion of patients in a vegetative or minimally conscious state have brain activation reflecting some awareness and cognition. Careful clinical examination will result in reclassification of the state of consciousness in some of these patients. This technique may be useful in establishing basic communication with patients who appear to be unresponsive.
We aim to improve the medical care and understanding of disorders of consciousness following an acute insult such as coma, vegetative state, minimally conscious state or locked-in syndrome. Coma Science Group Cyclotron Research Center & Neurology Dept University of Liège
Despite the importance of diagnostic accuracy, the rate of misdiagnosis of VS has not substantially changed in the past 15 years. Standardized neurobehavioral assessment is a more sensitive means of establishing differential diagnosis in patients with disorders of consciousness when compared to diagnoses determined by clinical consensus.
The Neuromedia Corner aims to share news and stimulate an effective dialogue about the state of the art of neuroscience technologies, their risks and benefits and the associated ethical and social issues. The Neuromedia Corner is an idea of the bid - Brains in Dialogue project.
The order by Mr Justice Baker was issued in a case involving a woman, who can be referred to only as "M". She has been in "a minimally conscious state" since suffering from swelling of the brain stem, which caused serious damage and wasting to the brain. The woman suffered the illness in 2003, when she was 43, and has been minimally conscious since then.
A mother is seeking a court's permission to withdraw life-sustaining artificial nutrition and hydration from her brain-damaged daughter. The woman, 53, who can only be referred to as "M" for legal reasons, is in a "minimally conscious state".
M. Schubert, A. Felfernig, and M. Mandl. Proceedings of the 2009 International Conference on Adaptive and Intelligent Systems, page 9-14. Klagenfurt, Austria, (2009)
K. Shchekotykhin, G. Friedrich, and D. Jannach. MBS 2008 - Workshop on Model Based Systems at ECAI 2008, Patras. Greece, page 7-12. University of Patras, (2008)