A recent article, published in the prestigious scientific journal BMC Medical Ethics, analyzes the important issue of assessing the level of consciousness in patients suffering from disorders at this level, which represents an urgent challenge for their attention, monitoring and care.

Its evaluation in people with verbal or behavioral disabilities, such as patients with disorders of consciousness, involves both ethical and care issues, in the difficult field of care for people with severe limitations to communicate, perceive, locate, interpret and integrate reality.

The rate of misdiagnosis among them raises the need for new perspectives to inspire new diagnostic, technical, and clinical approaches.

The characteristics of consciousness, on which the evaluation of its disorders is proposed, could be defined as:

1.- Qualitative wealth: patients with disorders of consciousness may be unable or only partially able to experience sight, sound, smell, taste, touch, pleasure or pain.

2.- Situation: the spatio-temporal location could be changing and discontinuous, as in the dream experience or altered states of consciousness, such as autoscopy (seeing yourself in a different place from where your body is), experience outside of the body (experiencing the world from a place outside your body), type II blindsight (having the sensation of non-visual perception), loss of individuality, or effects similar to those produced by the anesthetic ketamine, including hallucinations, flashbacks, and impaired attention and memory. Furthermore, bodily experience could be reformulated by brain damage, and this could affect consciousness.

3.- Intentionality: the experiences can be preserved on the possible residual consciousness, although possibly disconnected from a stable ability to refer those experiences.

4.- Integration: the totality of a conscious perception could be compromised, as well as the different elements of a scene and their different levels of detail.

5.- Dynamics and stability: residual conscious processing can be very unstable without any capacity for stabilization, unlike states of normal consciousness. Both the quantity and the dynamics of sensory input are drastically reduced in disorders of consciousness.

The authors state that, taking as a starting point this recently introduced list of operational indicators that facilitates their recognition in challenging cases such as non-human animals and Artificial Intelligence, they have explored their relevance in disorders and their potential ethical impact in the diagnosis and medical care of affected patients.

Indicators imply particular capacities that can be deduced from the observation of the behavior or the cognitive capacity of the subject in question. Although they do not allow defining a strict threshold to decide on the presence of consciousness, they can be used to infer a gradual measure based on the consistency between the different indicators.

The indicators under consideration offer a potentially useful strategy to identify and assess residual consciousness in patients with disorders of consciousness, setting the theoretical stage for the assessment of operability and quantification of relevant brain activity.

The paper concludes by stating that the heuristic analysis carried out supports the conclusion that the application of the identified indicators of consciousness will probably inspire new strategies to assess three very urgent problems: misdiagnosis of disorders; the need for a reference standard to detect consciousness and diagnose its disorders; and the need for a refined taxonomy of disorders of consciousness.


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