A “Stochastic Turn” in Patients with Unresponsive Wakefulness Syndrome

From High-rate Misdiagnosis to Care Methodology

Abstract

    The terminology ffor the “disorder of consciousness,” formerly classified broadly as “vegetative state,” has recently changed to unresponsive wakefulness syndrome (UWS) as a result of changes in its clinical implications. Daily care is essential for patients with UWS, and continual caregiving ensures the possibility of recovery (or discovery) even among patients who are only mildly affected by the syndrome. However, there exists no specific treatment corresponding to a precise diagnosis of the syndrome; proper care is often not provided to patients owing to a misdiagnosis. This paper argues that a conceptualization of UWS as a “stochastic turn” is crucial to ensure that clinical practices are followed and adequate care is provided to patients. To this end, we propose a probabilistic theory regarding the broad (assumed) criteria that should determine the diagnosis of the “unconscious state” and how these criteria should be established. We also show the ideal precondition for and presumption of the attitude of care, where patients are only in a communication disorder and may be conscious. Finally, we specify profitable and stochastic decision-making strategies in clinical practice and effective ways to communicate with patientsʼ families.