Awareness of self and the environment DQ 8

Awareness of self and the environment DQ 8

Awareness of self and the environment DQ 8

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)

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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.