A case for increased caution in end of life decisions for disorders of consciousness

Disorders of consciousness include coma, the vegetative state and the minimally conscious state. Such patients are often regarded as unconscious. This has consequences for end of life decisions for these patients: it is much easier to justify withdrawing life support for unconscious than conscious patients. Recent brain imaging research has however suggested that some patients may in fact be conscious. We argue that these new findings should lead us to be more cautious with regard to end of life decisions for this patient group. Additionally, we argue that if their lives are to be ended, then increased caution should be exercised to avoid undue suffering. As a consequence, the already difficult ethical and clinical questions surrounding these patients are made even more difficult with regard to making and acting on end of life decisions, as well as with regard to quality of life prognoses. The best we can hope for is that research both on disorders of consciousness and on the neural correlates of consciousness will progress more and make these kinds of questions easier to address in the future.