Clinical conversations surrounding the continuation or limitation of life-sustaining treatments (LLST) are both challenging and tragically necessary for patients with Disorders of Consciousness (DoC) following severe brain injury. Divergent cultural, philosophical, and religious perspectives contribute to vast heterogeneity in clinical approaches to LLST – as reflected in regional differences and inter-clinician variability. Here we provide an ethical analysis of factors that inform LLST decisions among patients with DoC. We begin by introducing the clinical and ethical challenge and clarifying the distinction between withdrawing and withholding life-sustaining therapy. We then describe relevant factors that influence LLST decision-making including diagnostic and prognostic uncertainty, perception of pain, defining a “good” outcome, and the role of clinicians. In concluding sections, we explore global variation in LLST practices as they pertain to patients with DoC and examine the impact of religious perspectives on approaches to LLST. Understanding and respecting the cultural and religious perspectives of patients and surrogates is essential for protecting patient autonomy and advancing goal-concordant care during critical moments of medical decision making.

中文翻译：

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意识障碍生命维持治疗的局限性：伦理与实践

对于严重脑损伤后出现意识障碍 (DoC) 的患者来说，围绕继续或限制生命维持治疗 (LLST) 的临床讨论既具有挑战性，又非常必要。不同的文化、哲学和宗教观点导致了 LLST 临床方法的巨大异质性——这反映在区域差异和临床医生间的差异上。在这里，我们对 DoC 患者中影响 LLST 决策的因素进行了伦理分析。我们首先介绍临床和伦理挑战，并澄清撤回和停止维持生命治疗之间的区别。然后，我们描述影响 LLST 决策的相关因素，包括诊断和预后不确定性、疼痛感知、定义“良好”结果以及临床医生的作用。在结论部分，我们探讨了与 DoC 患者相关的 LLST 实践的全球差异，并研究了宗教观点对 LLST 方法的影响。理解和尊重患者和代理人的文化和宗教观点对于在医疗决策的关键时刻保护患者自主权和推进目标一致的护理至关重要。