New taxonomy for prolonged disorders of consciousness may help with decisions on withdrawal of clinically assisted nutrition and hydration: A proposed decision-making pathway.
Liliana da Conceição Teixeira, Nuno Rocha, Rui Nunes
PMID 33871035WHAT IT FOUND
A proposed pathway suggests that for patients in vegetative or cortically mediated states, continuing nutrition and hydration is often not in their best interests.
This framework aims to clarify diagnosis and guide decisions on withdrawal of life-sustaining treatment.
Key findings
01The authors propose a decision-making pathway using a new taxonomy that includes covert cognition to guide clinicians on withdrawing clinically assisted nutrition and hydration.
02Under this proposed framework, patients in states 2a to 3b are assumed to not benefit from life-prolonging treatment, whereas those in state 4b should not have treatment withdrawn.
03The new terminology aims to reduce false expectations of recovery among relatives by removing the word 'consciousness' from diagnoses for patients who only localize stimuli.
STILL TO COME
How it was doneWhat they found
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What it does not show
This is a proposal and a theoretical framework, not a validated clinical tool. The authors state the taxonomy is not definitive and requires further study to refine criteria. The pathway relies on a specific interpretation of ethical principles regarding best interests and futility. No data is provided on the outcomes of patients managed via this pathway.
Declared interests
The authors have no conflicts of interest to declare.
The easy way to misread this
Do not treat this pathway as a validated standard of care or evidence that it improves patient outcomes. It is a theoretical proposal that requires further refinement and validation before it can be used to justify clinical decisions.