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Updated: Dec 13, 2025

Assessment and Communication for People with Disorders of Consciousness
Published on: August 1, 2017
Disorders of Consciousness and Disability Law
Joseph J Fins1, Megan S Wright2, Samuel R Bagenstos3
1Division of Medical Ethics, Weill Medical College of Cornell University; The Consortium for the Advanced Study of Brain Injury, Weill Cornell Medical College and The Rockefeller University, New York NY; and Yale Law School, New Haven, CT.
New guidelines address disorders of consciousness (DoC). Despite advancements, patients with DoC face misdiagnosis and inadequate care, violating disability laws and ethical standards.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Disability Law
Background:
- 2018 guidelines update assessment and treatment for disorders of consciousness (DoC).
- Previous standards from 1994 and 2002 are now superseded.
- DoC includes vegetative, minimally conscious, covert consciousness, and cognitive motor dissociation states.
Purpose of the Study:
- Analyze legal and ethical implications of the 2018 DoC practice guideline.
- Highlight patient vulnerability due to misdiagnosis and inadequate care.
- Advocate for improved care aligned with emerging standards and disability law.
Main Methods:
- Systematic evidence-based review and practice guideline analysis.
- Application of disability law, including the Americans with Disabilities Act and Olmstead v. L.C.
- Examination of clinical practice deficiencies and legal violations.
Main Results:
- Patients with DoC experience high rates of misdiagnosis, inadequate surveillance, pain management, rehabilitation, and segregation.
- These deficiencies contradict the dynamic nature of DoC and the national guideline's standard of care.
- Current care practices violate domestic and international disability laws.
Conclusions:
- The 2018 DoC guideline necessitates a re-evaluation of clinical practices.
- Legal frameworks, particularly disability law, mandate better integration and care for DoC patients.
- Ensuring equitable care for individuals with DoC is an ethical and legal imperative.
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