Fragments of Selves and The Importance of Emotionality: Ethicolegal Challenges in Assessing Capacities, Consent, and Communicating with MCS Patients and the Need for Guidelines

摘要

Bendtsen (2013) describes difficulties in providing reliable diagnoses of minimally conscious state (MCS), as patients' associated injuries may lead to compromised motor or perceptual abilities, potentially involving those abilities involved in communicating awareness, such as hearing, seeing, and movement; the article proposes strategies to manage consent and assent. I suggest that the central challenge is assessing decision-making capacity rather than diagnosis. Recent technological advances may permit reliable diagnoses ofMCS regardless of injuries affecting the potential for communication (Rosanova et al. 2012). Yet assessing MCS patients' comprehension and decision-making capacity is exceptionally complex, as truly autonomous decisions involve subjective values and emotionality, both likely to change as recovery proceeds. This impacts upon possibilities for consent and assent.