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Désordres de la conscience : Aspects éthiques

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Coma et états de conscience altérée

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Résumé

L’apparition de la ventilation mécanique dans les années cinquante et le développement des soins intensifs dans les années soixante ont permis à de nombreux patients de survivre à de graves lésions cérébrales. Bien que ces avancées technologiques soient étonnantes, de nombreux patients vont alors se retrouver dans des états cliniques critiques peu rencontrés auparavant (1). L’impact éthique de ces états d’inconscience se reflète lors de la rédaction des premiers comités de bioéthique et lors de léapparition du concept d’acharnement thérapeutique. En 1968, le comité spécial de l’école médicale de Harvard a publié un article essentiel redéfinissant la mort comme étant un coma irréversible et une perte permanente de toutes les fonctions cérébrales (2). Le comité, composé de dix médecins, d’un théologien, d’un avocat et d’un historien des sciences, a débattu des questions médicales, juridiques et sociétales quant à la prise en charge des patients en mort cérébrale. Nous donnerons ici un bref aperçu des principales questions éthiques liées à la notion de conscience et à la prise en charge médicale des patients atteints de troubles de la conscience (TDC) tels que le coma, l’état végétatif et l’état de conscience minimale. Nous mettrons également l’accent sur le problème de la gestion de la douleur et des prises de décision en fin de vie.

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Authors
  1. A. Demertzi
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  2. O. Gosseries
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  3. M.-A. Bruno
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  4. C. Schnakers
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  5. A. Vanhaudenhuyse
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  6. C. Chatelle
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  7. V. Charland
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  8. A. Thibaut
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  9. M. Thonnard
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  10. S. Laureys
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Demertzi, A. et al. (2011). Désordres de la conscience : Aspects éthiques. In: Coma et états de conscience altérée. Springer, Paris. https://doi.org/10.1007/978-2-8178-0127-8_15

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  • DOI: https://doi.org/10.1007/978-2-8178-0127-8_15

  • Publisher Name: Springer, Paris

  • Print ISBN: 978-2-8178-0126-1

  • Online ISBN: 978-2-8178-0127-8

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