An Empirical Study Of Ethical Issues Of Disorders Of Consciousness

For a long time,disorders of consciousness(DOC)has been marginalized in clinical diagnosis because of its speciality and relatively small amount of patients.With the increasing number of patients with disorders of consciousness,ethical issues such as end-of life decision and problems of uncertainty are increasingly highlighted during the treatment process.Developed countries such as the United States and the United Kingdom have constructed relatively mature treatment methods and ethical problem identification mechanisms,while China is still underdeveloped in this area,and academic research are few.Due to their special status,medical staff are directly responsible for caring for people with DOC.It is of great practical significance to empirically examine the ethical problems of patients with this diagnosis and to analyze them from Confucian perspective.In this paper,the ethical issues of the treatment of patients with disorders of consciousness are the research subjects,from the perspective of medical personnel,and combined with the caregiver’s point of view,to explore their cognition of relevant ethical issues,and to propose promising measures for specific problems.The thesis combines theory with empirical research,using literature review method,comparative analysis method,questionnaire survey and narrative medicine to study.Besides,empirical research and medical narrative as the main research methods,which is certain innovative.This paper is divided into four parts:Firstly,it introduces the definition of disorders of consciousness and distinguishes related medical concepts such as vegetative state and minimally conscious state.From the theoretical level,the main ethical issues are recognized,such as whether the life-sustaining treatment of patients with DOC should be stopped,whether the patients with DOC have personhood,etc.,which lays a theoretical foundation for further research.Secondly,we use the questionnaire survey to understand the cognition and attitude of medical staff and nursing staff on the ethical issues faced in the treatment of patients with DOC.The results show that most medical personnel adopt a double standard in the attitude of "permanent vegetative state is worse than death" between self and other.In other word,when imaging themselves are patients,they are inclined to agree this judgement.While the patients are others,they seems to disagree it.Most medical staff think patients with DOC have personhood which differs from the existing analysis of the moral status of patients with DOC in western countries;participants tend to provide life-sustaining treatment for patients with DOC,especially artificial nutrition and hydration.In order to test whether Chinese culture has an impact on the attitude of medical staff,the questionnaire involves whether the patient with DOC has personhood,whether the vegetative state is worse than death,whether to stop life-sustaining treatment and what is the most important ethical principle in treatment.The third part,based on Confucian traditional culture,analyzed the reasons behind the second part of medical staff and their families’ attitudes towards patients with disorders of consciousness,as well as the ethical issues they face.Among them,the uncertainty of diagnosis and prognosis,personhood,best interests and privacy protection are particularly prominent.Problems of uncertainty and best interests are often the primary considerations in practice,and privacy protection and personhood are often overlooked.The fourth part proposes the management strategies to solve the ethical problems of patients with DOC.First,the legal and economic support of national policies is indispensable,including the implementation of advance directives and the development of the functions of ethics committee.Secondly,medical staff need to work closely with their families to help train family members to care,where possible.Under the provision of home care for patients to reduce the burden on families;finally,non-governmental social support services include non-profit organization’s support and community functioning.