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A preliminary study of the characteristics of the psychological dissection techniques applied on the minimally conscious state
Published in Artde D.K.T. Lam, Stephen D. Prior, Siu-Tsen Shen, Sheng-Joue Young, Liang-Wen Ji, Smart Science, Design & Technology, 2019
To assist with trauma diagnosis, Giacino et al. (2002) published the definition of minimally conscious state (MCS) in medical research on brain injury (Giacino et al. 2002). MCS is mainly used to distinguish between coma, vegetative state (VS) and full-consciousness in the locked-in syndrome. In Giacino’s article, coma refers to a person who is unconscious with no spontaneous eye opening and unable to be awakened under strong stimulation. A person in a vegetative state is characterized by no identifiable behavioral evidence for self or environmental awareness, but is capable of spontaneous or stimulus-induced arousal, evidenced by sleep–wake cycles. A person with locked-in syndrome has preservation of cognition but is almost unable to express himself. Individuals in MCS are in a fluctuating state of consciousness. Although MCS is the result of serious neuropathology, behavioral evidence of consciousness is still discernible except that these behaviors occur inconsistently. As such, this person does not meet the criteria of vegetative state, and is therefore regarded as being in the minimally conscious state (Giacino et al. 2002).
Beyond the neural correlates of consciousness: using brain stimulation to elucidate causal mechanisms underlying conscious states and contents
Published in Journal of the Royal Society of New Zealand, 2021
Corinne A. Bareham, Matt Oxner, Tim Gastrell, David Carmel
The opposite combination – reduced awareness with high wakefulness – is seen in some clinical states caused by brain trauma, collectively known as disorders of consciousness (DOCs). The vegetative state is a DOC in which patients have sleep-wake cycles and spend long periods with their eyes open, but do not demonstrate any evidence of awareness or meaningful behaviour (Giacino et al. 2004; tellingly, this disorder is also commonly known as unresponsive wakefulness syndrome, Laureys et al. 2010). Some vegetative patients recover sufficiently to be recategorised as being in a minimally conscious state, where there is some – often inconsistent – evidence of awareness, such as responding appropriately to an instruction to follow a moving object with the eyes (Laureys et al. 2001).
Strengths of the French end-of-life Law as Well as its Shortcomings in Handling Intractable Disputes Between Physicians and Families
Published in The New Bioethics, 2020
Jonathan Messika, Noël Boussard, Claude Guérin, Fabrice Michel, Saad Nseir, Hodane Yonis, Claire-Marie Barbier, Anahita Rouzé, Virginie Fouilloux, Stephane Gaudry, Jean-Damien Ricard, Henry Silverman, Didier Dreyfuss
A 14-year-old girl, with a history of myasthenia gravis, was admitted to a paediatric ICU after an unwitnessed out-of-hospital cardiac arrest. A vegetative state was diagnosed based on the unfavourable clinical course coupled with electroencephalography and brain magnetic resonance imaging. Thirty days after ICU admission, a collegiate procedure was undertaken, in accordance to French Law. A decision to withdraw mechanical ventilation was recommended. The patient’s parents engaged the administrative court (‘référé-liberté’), in order to ask for an expert evaluation of their child’s prognosis, which the court ordered. The expert conclusions were congruent with the physicians in charge, and the administrative court stated, 168 days after ICU admission, that the decision to withdraw mechanical ventilation was legitimate. The parents, dissatisfied by this decision, chose to go to the Conseil d’Etat, which confirmed the judgment in the first instance, 197 days after ICU admission. The European Court of Human Rights, also engaged by the parents, confirmed this decision. Finally, it was decided to withdraw the respiratory support despite the opposition of the parents. The patient died after withdrawal of mechanical ventilation and due to the delays to arbitrate on the decision, death occurred one year after ICU admission. f. Case #66