Rethinking Disorders of Consciousness: New Research and Its Implications‪.‬

Over the past several years, deciding whether to withdraw life-sustaining therapy from patients who have sustained severe brain injuries has become much more difficult. The problem is not the religious fundamentalism that infused the debate over the care of Terry Schiavo, the Florida woman in a permanent vegetative state whose case has drawn national attention. Rather, the difficulty stems from emerging knowledge about the diagnosis and physiology of brain injury and recovery. The advent of more sophisticated neuroimaging techniques like MRI and PET scans, in tandem with electrophysiologic and observational studies of brain-injured patients, have led to an effort to differentiate disorders of consciousness more precisely. The crude categories that have informed clinical practice for a quarter century are becoming obsolete. It used to be enough for a neurologist or neurosurgeon to write a note in the chart grimly recording the patient's neurological exam and then concluding with the global statement, "no hope for meaningful recovery." It can no longer be so simple. With a better understanding of brain injury and mechanisms of recovery, we should be suspicious of blanket statements that might, we now believe, obscure important differences among different patients' prospects for recovery, although even those patients we now think may recover may still be left with profound and perhaps intolerable burdens of disability.