By Stacey Kusterbeck
Clinical professional society guidelines in America and Europe now recommend the use of advanced tests (such as functional magnetic resonance imaging [MRI] and electroencephalogram [EEG]) to search for covert consciousness in some patients who appear behaviorally unresponsive at the bedside after severe brain injury. “As a field, we are still in early stages of using advanced neurotechnologies to search for covert consciousness on a clinical basis,” reports Michael Young, MD, MPhil, a neurologist and researcher in the Division of Neurocritical Care at Massachusetts General Hospital and associate director of the MGH Neurorecovery Clinic.
Currently, only a handful of sites around the world have the requisite resources and expertise to perform these types of assessments. “But as efforts to democratize access to these techniques expand, it is likely that more organizations will be able to readily implement these guideline-directed tests,” predicts Young.
Young and colleagues developed a new ethical framework to guide clinicians in these complex cases.1 “As the availability of guideline-directed tests for covert consciousness grows, clinicians may benefit from guidance on how to responsibly interpret, share, and document results,” explains Young.
Ethical guidance for clinicians is crucial to ensure responsible implementation of these novel neurotechnologies in clinical practice. Clinicians also need help communicating to families about the highly sensitive and complex results the technology yields. “At this nascent stage, ethicists have a formative role to play in developing policies and educating clinicians on responsible approaches to implementation and communication,” says Young.
To ensure that disclosure of test results for covert consciousness is handled ethically, the authors emphasize the importance of transparent, empathic communication. Clinical ethics consultants could play crucial roles throughout the continuum of care for patients with disorders of consciousness in these ways, suggests Young:
• by managing normative uncertainties;
• by helping to refine care goals;
• by addressing any conflicts that arise between or among surrogates and clinicians;
• by clarifying optimal care approaches when a patient with disorders of consciousness has no identified surrogate decision-maker.
“Ethicists can harmonize cross-cultural or philosophical differences in how consciousness may be viewed or valued,” adds Young.
- Young MJ, Kazazian K, Fischer D, et al. Disclosing results of tests for covert consciousness: A framework for ethical translation. Neurocrit Care 2024; Jan 19. doi: 10.1007/s12028-023-01899-8. [Online ahead of print].
