Our closing session will provide a timely update on the ethical challenges inherent in the management of patients with DoC. Caring for patients with DoC may present financial, medical and/or ethical conundrums. Although severe brain injuries represent a fraction of the population of persons with acquired brain injury, their cost of care is high (around $4 billion in direct medical costs per year), mostly due to long term care needs. There is frequently still the belief that severe brain injuries typically result in poor functional outcomes, leading to low priority in the allocation of medical and financial resources towards the treatment of such patients. Yet, large national clinical initiatives, such as the USA TBI Model Systems have shown this to be a fallacy. Although slower to recover, around 30% of patients with DoC (unable to respond to command at discharge from inpatient rehabilitation) function independently within 2 to 5 years post-injury. This data must lead to a drastic shift in mentality and in the way we care for these patients. In this context, the American Academy of Neurology (AAN) and the European Academy of Neurology (EAN) recently published guidelines regarding diagnosis of patients with DOC. Such guidelines represent a positive first step in improving DoC care. Finally, the emergence of challenging clinical entities (covert awareness) and innovative treatments has led to a need for reassessing end-of-life decision making in this frequently neglected group of patients.
Clinical Decision-Making in Adult Patients with DoC
James L. Bernat, USA
Clinical Decision-Making in Pediatric Patients with DoC
Erika Molteni, UK
Disorders of Consciousness And Disability Rights
Joseph Fins, USA
Philippe Azouvi France