Article (Scientific journals)
Pain perception in disorders of consciousness: Neuroscience, clinical care, and ethics in dialogue
Demertzi, Athina; Racine, Eric; Bruno, Marie-Aurélie et al.
2013In Neuroethics, 6 (1), p. 37-50
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Keywords :
Pain; End-of-life; Vegetative state; Minimally conscious state; Ethics; Attitudes; Survey
Abstract :
[en] Pain, suffering and positive emotions in patients in vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious states (MCS) pose clinical and ethical challenges. Clinically, we evaluate behavioural responses after painful stimulation and also emotionally-contingent behaviours (e.g., smiling). Using stimuli with emotional valence, neuroimaging and electrophysiology technologies can detect subclinical remnants of preserved capacities for pain <br />which might influence decisions about treatment limitation. To date, no data exist as to how healthcare providers think about end-of-life options (e.g., withdrawal of artificial nutrition and hydration) in the presence or absence of pain in non-communicative patients. Here, we aimed to better clarify this issue by re-analyzing previously published data on pain <br />perception (Prog Brain Res 2009 177, 329–38) and end-of-life decisions (J Neurol 2010 258, 1058–65) in patients with disorders of consciousness. In a sample of 2259 European healthcare professionals we found that, for VS/UWS more respondents agreed with treatment withdrawal when they considered that VS/UWS patients did not feel pain (77%) as compared to those who thought VS/UWS did feel pain (59%). This interaction was influenced by religiosity and professional <br />background. For MCS, end-of-life attitudes were not influenced by opinions on pain perception. Within a contemporary ethical context we discuss (1) the evolving scientific understandings of pain perception and their relationship to existing clinical and ethical guidelines; (2) the discrepancies of attitudes within (and between) healthcare providers and their consequences for <br />treatment approaches, and (3) the implicit but complex relationship between pain perception and attitudes toward life-sustaining treatments.
Disciplines :
Neurology
Author, co-author :
Demertzi, Athina  ;  Université de Liège - ULiège > Centre de recherches du cyclotron
Racine, Eric;  Université de Montréal
Bruno, Marie-Aurélie ;  Université de Liège - ULiège > Centre de recherches du cyclotron
LEDOUX, Didier  ;  Centre Hospitalier Universitaire de Liège - CHU > Autres Services Médicaux > Service des soins intensifs
Gosseries, Olivia  ;  Université de Liège - ULiège > Centre de recherches du cyclotron
Vanhaudenhuyse, Audrey  ;  Université de Liège - ULiège > Centre de recherches du cyclotron
Thonnard, Marie ;  Université de Liège - ULiège > Centre de recherches du cyclotron
Soddu, Andrea ;  Université de Liège - ULiège > Centre de recherches du cyclotron
MOONEN, Gustave  ;  Centre Hospitalier Universitaire de Liège - CHU > Neurologie Sart Tilman
Laureys, Steven  ;  Université de Liège - ULiège > Centre de recherches du cyclotron
Language :
English
Title :
Pain perception in disorders of consciousness: Neuroscience, clinical care, and ethics in dialogue
Publication date :
2013
Journal title :
Neuroethics
ISSN :
1874-5490
eISSN :
1874-5504
Publisher :
Springer
Volume :
6
Issue :
1
Pages :
37-50
Peer reviewed :
Peer reviewed
Available on ORBi :
since 12 February 2012

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