Ethics of neuroimaging after serious brain injury

BMC Medical Ethics 15 (1):41 (2014)

Authors
Charles Weijer
University of Western Ontario
Abstract
Patient outcome after serious brain injury is highly variable. Following a period of coma, some patients recover while others progress into a vegetative state (unresponsive wakefulness syndrome) or minimally conscious state. In both cases, assessment is difficult and misdiagnosis may be as high as 43%. Recent advances in neuroimaging suggest a solution. Both functional magnetic resonance imaging and electroencephalography have been used to detect residual cognitive function in vegetative and minimally conscious patients. Neuroimaging may improve diagnosis and prognostication. These techniques are beginning to be applied to comatose patients soon after injury. Evidence of preserved cognitive function may predict recovery, and this information would help families and health providers. Complex ethical issues arise due to the vulnerability of patients and families, difficulties interpreting negative results, restriction of communication to “yes” or “no” answers, and cost. We seek to investigate ethical issues in the use of neuroimaging in behaviorally nonresponsive patients who have suffered serious brain injury. The objectives of this research are to: (1) create an approach to capacity assessment using neuroimaging; (2) develop an ethics of welfare framework to guide considerations of quality of life; (3) explore the impact of neuroimaging on families; and, (4) analyze the ethics of the use of neuroimaging in comatose patients
Keywords Ethics  Brain injury  Vegetative state  Unresponsive wakefulness syndrome  Minimally conscious state  Functional magnetic resonance imaging  Electroencephalography  Decision making capacity  Informed consent  Quality of life  End of life care
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DOI 10.1186/1472-6939-15-41
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Brain Damage and the Moral Significance of Consciousness.Julian Savulescu - 2009 - Journal of Medicine and Philosophy 34 (1):6-26.

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