Advances in brain imaging promise to improve diagnostic and prognostic assessments of patients in the vegetative state. In a new study, neuroethicists discuss the associated ethical and social problems and suggest ways of approaching them.

Modern intensive care medicine can preserve the vital functions of individuals who have life-threatening illnesses or suffered a serious trauma, including permanent brain damage. With the help of medical technology, many patients can be kept alive for decades in the so-called “persistent vegetative state”, in which they show no clinical signs of responsiveness. Under these circumstances, the choice of appropriate therapeutic interventions raises complex clinical and ethical problems for the relatives of these patients and the medical professionals who care for them.

During the past 10 years, novel imaging techniques have been developed which permit unprecedented insights into brain function. Although these methods have not yet become standard practice, physicians are increasingly confronted with the problem of how they should best be used for diagnosis and prognosis in clinical settings. LMU neurologist Ralf J. Jox has just published a new study in which he and his co-authors examine the ethical and social issues that arise in this context.

“Our aim is to develop concrete recommendations for doctors in two areas: firstly how they can best communicate with the relatives of patients, and secondly how decisions concerning life-preserving measures should be informed by the goal of care that is pursued,” says Jox. As he sees it, the crucial factor is the need to engage in intensive discussions with relatives with a view to setting out clearly the advantages and limits of the therapeutic options available, thus helping all concerned to make appropriate decisions in the best interests of the patient.

The study was carried out as part of an international research project devoted to the neuroethics of the vegetative state. The ethical, legal, social and medical aspects of the condition are discussed in greater detail in a new book entitled "Vegetative State - A Paradigmatic Problem of Modern Societies", edited by Jox, together with the Canadian neuroethicist Eric Racine and his own colleagues at LMU. (The Lancet Neurology, August 2012)