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    A seventeen-year-old in a locked-in state could communicate her wishes via eye blinks. This case highlights the importance of seeking direct patient consent, even in severe neurological conditions.

    Keywords:
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    Area of Science:

    • Neuroscience
    • Medical Ethics
    • Clinical Neurology

    Background:

    • A patient, Tiffany, sustained a brain stem injury at age seventeen, resulting in a permanently locked-in state.
    • She remained fully conscious but with severely limited motor control, only able to move her eyes.
    • Life-sustaining treatment was initiated, with her mother desiring continued prolonged care.

    Purpose of the Study:

    • To explore the ethical considerations of decision-making for patients in a locked-in state.
    • To advocate for direct communication with patients regarding their own treatment preferences, regardless of physical limitations.

    Main Methods:

    • A communication system using eye blinks (one for yes, two for no) was established by the neurologist.
    • A clinical ethicist was consulted to facilitate discussions between medical staff, family, and the patient.
    • Direct questioning of the patient regarding her treatment desires was proposed.

    Main Results:

    • The established communication method allowed the patient to respond to questions.
    • The ethicist's intervention aimed to elicit the patient's own wishes, diverging from solely family-directed decisions.

    Conclusions:

    • It is crucial to seek and respect the patient's autonomy and informed consent, even when communication is challenging.
    • Clinical ethicists play a vital role in ensuring patient-centered care and advocating for direct patient voice in treatment decisions.