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Disorders of Consciousness, Past, Present, and Future

Published online by Cambridge University Press:  13 August 2019

JOSEPH J. FINS
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Abstract:

This paper, presented as the 2019 Cambridge Quarterly Neuroethics Network Charcot Lecture, traces the nosology of disorders of consciousness in light of 2018 practice guidelines promulgated by the American Academy of Neurology, the American College of Rehabilitation Medicine and the National Institute on Disability, Independent Living and Rehabilitation Research. By exploring the ancient origins of Jennett and Plum’s persistent vegetative state and subsequent refinements in the classification of disorders of consciousness—epitomized by the minimally conscious state, cognitive motor dissociation, and the recently described chronic vegetative state—the author argues that there is a counter-narrative to the one linking these conditions to the right to die. Instead, there is a more nuanced schema distinguishing futility from utility, informed by technical advances now able to identify covert consciousness contemplated by Jennett and Plum. Their prescience foreshadows recent developments in the disorders of consciousness literature yielding a layered legacy with implications for society’s normative and legal obligations to these patients.

Keywords

persistent vegetative statepermanent vegetative statechronic vegetative statedisorders of consciousnesspractice guidelinedisorders of consciousnessneuroethicsdisability rightsKaren Ann QuinlanFred PlumBryan Jennett
Type
Article
Information
Cambridge Quarterly of Healthcare Ethics , Volume 28 , Special Issue 4: Clinical Neuroethics , October 2019 , pp. 603 - 615
Copyright
Copyright © Cambridge University Press 2019 

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Footnotes

Acknowledgements: Earlier versions of this talk were presented as a plenary session at the 13th World Congress on Brain Injury, International Brain Injury Association and as the Nicholas E. Davies Memorial Award Lecture at the 100th Annual Meeting, American College of Physicians. The author would like to acknowledge John and Eva Usdan for their generous support of his work.

References

Notes

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