In a recent issue of Internal Medicine Journal, Anderson etal. discussed end-of-life decision-making in patients with a Locked-in syndrome (LIS) after catastrophic pontine stroke.1 They stated that as prognosis may vary over time and early complications can reduce the patient's access to early intensive rehabilitation, judgements about end-of-life decision-making are more difficult for patients with LIS than other types of stroke patients. Furthermore, they mention that it may be difficult to establish decision-making competency in patients with LIS, because of limitations in communication, but that in time it is possible to validly assess cognitive abilities in these patients. They also comment that LIS patients are extremely vulnerable and that it is essential that the highest ethical standards be used in order to ensure that their interests and rights are fully protected.
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