PHI3633WK5-B.pdf

The Unconscious States
Awareness of self and the environment: internal / external (difficulties)

(lack of response to painful stimulus)

clinical definitions of:

• coma (Glasgow Coma Scale) (induced coma)

• persistent vegetative state (PVS)

• traumatic head injury

• brain hypoxia

• epileptic seizure

• syncope

• other unconscious states (ex. Locked-in syndrome)

CONSCIOUSNESS:

Awareness of self and the environment: internal / external

(difficulties; how to measure?)

UNCONSCIOUSNESS:

Lack of response to painful stimulus

Coma (Glasgow Coma Scale) (induced coma)

persistent (permanent) vegetative state (PVS)
VS MCS

MAGNETIC RESONANCE IMAGING (MRI)

Traumatic Brain Injury (TBI)

• complex injury

• broad spectrum of symptoms

• and disabilities

Mayo Clinic: TraumaticBrainInjury.com

TBI
mild

severe
~ 30 min.

Brain Hypoxia (anoxia)

3 PAIRS OF ARTERIES TO THE HEAD:

• 1 PAIR VERTEBRAL

• 2 PAIRS CAROTID

Epileptic Seizure (epileptic fit)

Neuronal activity:

• Abnormal
• Excessive
• Generalized
• Synchronous

Electro-EncephaloGram (EEG)

Syncope (fainting):

• Temporary loss of consciousness

• Sudden drop in blood pressure

Other unconscious states:

• Non-epileptic seizure

• Locked-in syndrome

• Etc.

LOCKED-IN SYNDROME:

• Aware

• cannot move or communicate verbally

• complete paralysis of nearly all voluntary muscles

• Except for vertical eye movements and blinking

Damage to specific portions of the lower brain

and brainstem, with no damage to the upper

brain (cerebral cortex).

MAGNETIC RESONANCE IMAGING (MRI)

POSITRON EMISSION TOMOGRAPHY (PET)

COMPUTED TOMOGRAPHY (CT)

VEGETATIVE
STATE

MINIMALLY
CONSCIOUS
STATE

LOCKED-IN
SYNDROME

(MRI)

DIAGNOSIS -> PROGNOSIS

MANAGEMENT, RELIEF: PAIN / SUFFERING

BIOETHICAL ANALYSIS: BENEFIT / BURDEN

BIOETHICAL MEANS OF LIFE SUPPORT:

• ORDINARY (PROPORTIONATE) / EXTRAORDINARY (DISPROPORTIONATE)

CLINICAL MEANS OF LIFE SUPPORT:

• STANDARD MEDICAL PRACTICE / EXPERIMENTAL TREATMENT

ETHICAL OBLIGATION RE. VITAL ORGANS: ASSIST / SUBSTITUTE

WHEN TO WITHHOLD OR WITHDRAW LIFE SAVING TREATMENT?

ERD

32. While every person is obliged to use
ordinary means to preserve his or her health,
no
person should be obliged to submit to a health
care procedure that the person has judged,
with a free and informed conscience, not to
provide a reasonable hope of benefit without
imposing excessive risks and burdens on the
patient or excessive expense to family or
community.

33. The well-being of the whole person must
be taken into account in deciding about any
therapeutic intervention or use of technology.
Therapeutic procedures that are likely to
cause harm or undesirable side-effects can be
justified only by a proportionate benefit to
the patient

56. A person has a moral obligation to use
ordinary or proportionate means of preserving
his or her life. Proportionate means are those
that in the judgment of the patient offer a
reasonable hope of benefit and do not entail
an excessive burden or impose excessive
expense on the family or the community.

57. A person may forgo extraordinary or
disproportionate means of preserving life.
Disproportionate means are those that in the
patient’s judgment do not offer a reasonable
hope of benefit or entail an excessive burden,
or impose excessive expense on the family
or the community.

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