Ethics of neuroimaging after serious brain injury

BMC Medical Ethics

Adrian M Owen³  Bryan Young²  Kathy Speechley¹  Loretta Norton³  Lorina Naci³  Andrea Lazosky⁶  Laura E Gonzalez-Lara³  Teneille Gofton²  Davinia Fernández-Espejo³  Damian Cruse³  Mackenzie Graham⁷  Fiona Webster⁴  Andrew Peterson³  Charles Weijer⁵ 

[1] Department of Pediatrics, Children’s Hospital of Western Ontario, London, ON, N6C 2V5, Canada;Department of Clinical Neurological Sciences, London Health Sciences Centre–University Hospital, London, ON, N6A 5A5, Canada;Brain and Mind Institute, Western University, London, ON, N6A 5B7, Canada;Department of Family and Community Medicine, University of Toronto, Toronto, ON, M5G 1V7, Canada;Department of Epidemiology and Biostatistics, Western University, London, ON, N6A 5C1, Canada;Department of Psychiatry, London Health Sciences Centre–Victoria Hospital, London, ON, N6A 5W9, Canada;Rotman Institute of Philosophy, Western University, London, ON, N6A 5B8, Canada

关键词: End of life care;    Quality of life;    Informed consent;    Decision making capacity;    Electroencephalography;    Functional magnetic resonance imaging;    Minimally conscious state;    Unresponsive wakefulness syndrome;    Vegetative state;    Brain injury;    Ethics;   

Others  :  799519
DOI  :  10.1186/1472-6939-15-41

 received in 2014-02-10, accepted in 2014-04-29,  发布年份 2014

【 摘 要 】

Background

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.

Methods/Design

Our research program encompasses four projects and uses a mixed methods approach. Project 1 asks whether decision making capacity can be assessed in behaviorally nonresponsive patients. We will specify cognitive functions required for capacity and detail their assessment. Further, we will develop and pilot a series of scenarios and questions suitable for assessing capacity. Project 2 examines the ethics of welfare as a guide for neuroimaging. It grounds an obligation to explore patients’ interests, and we explore conceptual issues in the development of a quality of life instrument adapted for neuroimaging. Project 3 will use grounded theory interviews to document families’ understanding of the patient’s condition, expectations of neuroimaging, and the impact of the results of neuroimaging. Project 4 will provide an ethical analysis of neuroimaging to investigate residual cognitive function in comatose patients within days of serious brain injury.

【 授权许可】

   
2014 Weijer et al.; licensee BioMed Central Ltd.

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