Prognosis Matters, Not Diagnosis

摘要

Fischer and Truog (2013) propose interactive capacity as a threshold marker for determining consciousness in patients with severe brain injuries. This can reduce the incidence of misdiagnosing minimally conscious patients as vegetative and can achieve diagnostic clarity in distinguishing these two groups of patients. It can also provide guidance for surrogates and clinicians in deciding whether to continue or terminate life-sustaining treatment (LST) for those with disorders of consciousness. This is usually in the form of artificial nutrition and hydration (ANH). The authors claim that patients "could be harmed by the termination of LST in circumstances where they are conscious" (31). They also claim that patients "could be harmed by the unwanted continuation of LST in circumstances where they lack consciousness"(31). These claims suggest that treatment decisions hinge largely if not entirely on the presence or absence of awareness.