The facilities which accept patients who have been diagnosed with locked-in syndrome or persistent vegetative state (PVS) face may ethical and moral decisions as well as the need to comfort patient’s families. The assessment of such persons is difficult since the alterations in their arousal do not let the clinicians have a conversation with a patient. Currently, many institutions search for ways to improve the state of patients with these conditions. According to Huether and McCance (2017), patients’ levels of awareness and cognitive function are different from their arousal in such cases. For example, PVS is characterized by the complete lack of self-awareness, while people with locked-in syndrome can comprehend the world around them but cannot communicate. Facilities that focus on locked-in state center on finding ways of including patients in the communication about their health.
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The outcomes for patients with alterations in awareness are often negative. Some facilities choose to offer comforting measures to people whose condition is severe, but the family can ask for other approaches. Persons with no means of communication are unable to decide for themselves whether their care should stop or continue. Therefore, their lives, in many cases, are in the hands of their caretakers. Maiser, Kabir, Sabsevitz, and Peltier (2016) present a different situation, discussing a patient whose locked-in syndrome did not stop him from choosing his fate. The 54-year-old man has decided to continue life-prolonging care, and his decision-making ability was taken into consideration by the facility. The researchers, thus, discuss how much can an institution do to support unbiased care for such persons.
It is unclear, however, how can these institutions determine the reliability of a patient’s cognitive ability. Maiser et al. (2016) state that the degree to which patients with locked-in syndrome possess the ability to make decisions is insufficiently researched. Nonetheless, they argue that even persons with an acute condition should have a chance to determine the approach to care. The main points for participation in decision-making are that these patients can receive information and understand it. Moreover, they should also engage their logical thinking to weigh the benefits and the risks, and, finally, to express a decision in one way or another. As a result, such facilities may view patients’ participation as one of the positive aspects of their outcome.
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.
Maiser, S., Kabir, A., Sabsevitz, D., & Peltier, W. (2016). Locked-in syndrome: Case report and discussion of decisional capacity. Journal of Pain and Symptom Management, 51(4), 789-793.