期刊
JOURNAL OF MEDICAL ETHICS
卷 -, 期 -, 页码 -出版社
BMJ PUBLISHING GROUP
DOI: 10.1136/jme-2023-109424
关键词
Consciousness; Decision Making; Ethics- Medical; Philosophy- Medical
This article presents a possible procedure that generates case-specific probabilistic assessments for patients with cognitive-motor dissociation (CMD) by evaluating degrees of evidence, using patient-centered priors, and conveying assessments through standardized probability yardsticks.
Some patients, following brain injury, do not outwardly respond to spoken commands, yet show patterns of brain activity that indicate responsiveness. This is 'cognitive-motor dissociation' (CMD). Recent research has used machine learning to diagnose CMD from electroencephalogram recordings. These techniques have high false discovery rates, raising a serious problem of inductive risk. It is no solution to communicate the false discovery rates directly to the patient's family, because this information may confuse, alarm and mislead. Instead, we need a procedure for generating case-specific probabilistic assessments that can be communicated clearly. This article constructs a possible procedure with three key elements: (1) A shift from categorical 'responding or not' assessments to degrees of evidence; (2) The use of patient-centred priors to convert degrees of evidence to probabilistic assessments; and (3) The use of standardised probability yardsticks to convey those assessments as clearly as possible.
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