Abstract
The Minimally Conscious State is a relatively new state, defined in order to separate patients who show signs of conscious awareness from those who are otherwise vegetative. Extensive research in this area has allowed for production of a definition, and from that, application of diagnostic testing and management strategies, usually adapted from those previously used in vegetative patients. There has been much research around the applicability of these tests and strategies in situations of minimally conscious states, including research by Owen and Coleman, which found that bedside assessment of awareness might not be sensitive to changes in consciousness in these patients.
In this thesis I argue that until we have clear and reproducible diagnostic and prognostic guidelines, situations of minimally conscious patients should be approached carefully, and with a patient-centered view of management. This is consistent with work by Honeybul et al., which describes concepts such as the Risk of Unacceptable Badness (RUB), substantial benefit and futility. A patient-centered sanctity of life clause should be applied in these situations, essentially a consideration as to what each patient would consider just and unjust procedures: procedures that would harm what they consider to be a life well lived.
I also include discussion about previous legal cases of patients either in vegetative states or other similar disorders of consciousness, particularly in terms of how they were viewed in court i.e. whether there were any particular commitments to clauses such as sanctity of life. Ultimately decisions in these situations should be kept out of the courtroom; in order to do that, doctors need to be considerate of patient world-views, and aware of concepts such as sanctity of life and their applications.