Against Futility Judgments for Patients with Prolonged Disorders of Consciousness

Photo by National Cancer Institute on Unsplash ABSTRACT Medical futility judgments for patients in prolonged disorders of consciousness (PDOC) frequently lead to withdrawal of life-sustaining treatment (LST), which is the leading cause of death for patients with traumatic brain injuries. The field of disorders of consciousness is pervaded by much uncertainty due to limitations on our current diagnostic tools, treatments, and outcome measures. In contrast, futility judgments are made in empirically tenuous confidence in the patient’s inability to survive or recover meaningfully. Despite emerging empirical evidence of PDOC patients’ potential for long-term recovery, an increasing sense of clinical nihilism leads to earlier and more frequent withdrawal of LST. In this paper, I argue against two kinds of futility judgments that may be used to justify the withdrawal of LST for PDOC patients: overly pessimistic predictions about the patient’s likelihood for meaningful recovery and rationing decisions that redirect hospital resources to patients who are more likely to recover. INTRODUCTION Brain injury is one of the leading causes of death and disability among children, young adults, and adults over the age of 75 years in the United States.[1] Yet we remain far from successfully diagnosing and treating brain injury patients who stay in states of prolonged disorders of consciousness. For this paper, the term “prolonged disorders of consciousness” means a vegetative state or a minimally conscious state, characterized by minimal to no signs of awareness up to and potentially exceeding five years.[2] Inadequate outcome measures and lack of empirical data for accurately predicting prolonged disorders of consciousness often force clinicians to assess patients based on their medical experience, knowledge of the medical literature, and clinical intuitions.[3] Futility judgments are clinical judgments made by healthcare providers about their patient’s health that can lead them to discontinue life-sustaining treatment. Dan Brock ...