Deans' stroke musings: Brain patterns cannot reveal end-of-life decisions for patients with severe brain injuries

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, March 14, 2017

Brain patterns cannot reveal end-of-life decisions for patients with severe brain injuries

If you have locked-in-syndrome you better hope your ER doctors are using these rather than going directly to end-of-life.

New Algorithms Search for Signs of Consciousness in Brain Injury Patients

PET Scans Predict Coma Outcome

The latest here:

Brain patterns cannot reveal end-of-life decisions for patients with severe brain injuries

A growing field of research is examining the brain patterns produced by people with severe brain injuries who can no longer communicate and appear to be in a vegetative state. Some have argued that one day we may be able to unlock a code from these patterns and communicate with these patients.
Two UBC neuroethicists are studying what this might mean for Canada and other countries that have recently introduced legislation for physician-assisted death. In a JAMA Neurology article published last week, Judy Illes and Emanuel Cabral examine the ethics around end-of-life decision-making for patients with these injuries.

Are there any examples in Canada or in other countries where patients with severe brain injuries who were unable to communicate have been able to access physician-assisted death?
EC: So far in Canada, there are no known cases of patients with brain trauma who have tried to access physician-assisted death. In the United States and the
Netherlands, there have been cases where patients with brain trauma have been asked whether they wanted to prolong their life. In all of these cases, the patients suffered from a specific form of brain trauma called locked-in syndrome. Essentially, these people maintain a good awareness and understanding of their surroundings, but are unable to verbally communicate because they are practically paralyzed within their own bodies. In most cases, patients manage to communicate through eye-blinking or restricted body movements, and sometimes using an alphabet board.

In one such case, physicians in the United States were able to assess one man’s memory and thinking by communicating through small head movements. They also allowed him to make decisions on receiving life-prolonging treatments using this method. In another case in the Netherlands, another man with locked-in syndrome used blinking to communicate that he wanted physician-assisted death. After several weeks of consulting with the patient, other physicians and the family, the patient was administered life-ending drugs.
JI: These patients have used indirect “codes” to express their end-of-life preferences. Some people might logically suggest that we can use brain imaging as the “code” to communicate with people in minimally conscious states and that hypothetically, this could open legal avenues for these patients to request physician-assisted death. Our paper anticipates this question and addresses the issues around it.
How likely is it that we will be communicating with patients about end-of-life decisions by analyzing their brain patterns?
JI: The public is already asking. We need both to anticipate such questions and be prepared to be responsive to them as a professional community.
EC: The idea seems far-fetched, however, studies have shown that it might be possible to use brain imaging to communicate with patients in minimally conscious states. As it stands, this communication channel is still quite weak but as research continues, it has led to questions about whether this type of communication might be applied to end-of-life care.
Under Canadian law, verbal communication is not a requirement for physician-assisted death. However, if the person has difficulty communicating, everything must be done to provide a reliable way through which the person can understand the information that is provided to them and communicate their decision. Currently, no such system exists to do so with patients in minimally conscious states.
What are your concerns about using this form of communication?
EC: People with severe brain trauma make up a highly vulnerable and historically neglected population whose health is placed in the hands of family members or health professionals. If we consider feminist ethics and disability ethics, they both emphasize that we have to be certain that the person fully understands the information given to them and their expressed wishes are clear.
JI: There is a huge leap however between communicating directly with someone, communicating through a tool like a spelling board, and using statistical interpretation of brain signals as a sign of preference or desire. We would need to be absolutely certain that the answers interpreted through brain imaging are what patients intended to express, and that their answers reflect reproducible, intact decision-making abilities. Researchers are still working out how to interpret the different signals that injured brains produce.