The Problems With Fixating on Consciousness in Disorders of Consciousness

Abstract

Distinguishing between disorders of consciousness, particularly between the vegetative state/unresponsive wakefulness syndrome (VS/UWS) and the minimally conscious state (MCS), has been a growing concern. As VS/UWS patients are considered unconscious and MCS patients are considered conscious, this distinction has had profound medical, social, legal, and ethical implications. However, we argue that that this distinction is not tenable, both ontologically (i.e., states of consciousness and unconsciousness are not binary) and epistemologically (i.e., we cannot know whether many patients are conscious or unconscious). As such, when making decisions about these patients, we advocate for deemphasizing the diagnostic distinction between the conscious and unconscious, and focusing more on observable behaviors and characteristics, according to patients' values. Although this approach will add complexity to patient management, it is crucial to providing honest and ethical care.

Keywords:

• brain injury
• consciousness
• decision making
• minimal consciousness
• neuroethics
• permanent vegetative state