Pain Perception in Disorders of Consciousness: Neuroscience, Clinical Care, and Ethics in Dialogue

Pain, suffering and positive emotions in patients in vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious states (MCS) pose clinical and ethical challenges. Clinically, we evaluate behavioural responses after painful stimulation and also emotionally-contingent behaviours (e.g., smiling). Using stimuli with emotional valence, neuroimaging and electrophysiology technologies can detect subclinical remnants of preserved capacities for pain which might influence decisions about treatment limitation. To date, no data exist as to how healthcare providers think about end-of-life options (e.g., withdrawal of artificial nutrition and hydration) in the presence or absence of pain in non-communicative patients. Here, we aimed to better clarify this issue by re-analyzing previously published data on pain perception (Prog Brain Res 2009 177, 329–38) and end-of-life decisions (J Neurol 2010 258, 1058–65) in patients with disorders of consciousness. In a sample of 2259 European healthcare professionals we found that, for VS/UWS more respondents agreed with treatment withdrawal when they considered that VS/UWS patients did not feel pain (77%) as compared to those who thought VS/UWS did feel pain (59%). This interaction was influenced by religiosity and professional background. For MCS, end-of-life attitudes were not Neuroethics (2013) 6:37–50 DOI 10.1007/s12152-011-9149-x A. Demertzi and E. Racine contributed equally to the manuscript. A. Demertzi (*) :M.-A. Bruno :D. Ledoux : O. Gosseries :A. Vanhaudenhuyse :M. Thonnard : A. Soddu : S. Laureys Coma Science Group, Cyclotron Research Center, University of Liège, Liège, Belgium e-mail: [email protected] A. Demertzi :M.-A. Bruno :O. Gosseries : A. Vanhaudenhuyse :M. Thonnard :A. Soddu : G. Moonen : S. Laureys CHU Neurology Department, University Hospital of Liège, Liège, Belgium E. Racine Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Montreal, Canada E. Racine Department of Medicine and Department of Social and Preventive Medicine, Université de Montréal, Montreal, Canada E. Racine Departments of Neurology and Neurosurgery, Medicine & Biomedical Ethics Unit, McGill University, Montreal, Canada D. Ledoux CHU Department of Intensive Care, University of Liège, Liège, Belgium G. Moonen University of Liège, Liège, Belgium Author's personal copy