• Monique Lanoix.
• Department of Philosophy and Religion, Appalachian State University, Boone, NC 28608-2104, USA. lanoixm@appstate.edu
• Brain Inj. 2010 Jan 1; 24 (11): 1336-42.

BackgroundIndividuals suffering from severe disorders of consciousness (DOC) face a bleak prognosis and are susceptible to therapeutic neglect according to Fins. Because of the increasing occurrence of severe brain injury, some physicians and researchers take the study of DOC to be a moral imperative and perceive novel technologies, such as Deep Brain Stimulation (DBS), as offering potential therapeutic benefit.MethodThis article examines the decisional process faced by proxy decision-makers for patients with severe DOC when confronted by novel treatments such as DBS.ResultsIf there is awareness in the literature that surrogate consent is complicated by the contingencies of severe brain injury such as disability and the possibility of long-term care, surrogate consent is often equated with substituted judgement and taking the best interests of the patient into account. However, for surrogates of patients with severe DOC, advocacy becomes a central component of the surrogate's role as there is no established standard of care for these patients in the post-acute phase. If participation in research is offered, the surrogate may perceive research participation as a way of providing benefits such as stimulation and some rehabilitation services for the patient.ConclusionResearchers need to be aware how the absence of a standard of care can shape surrogate choice.

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