Ethical issues in states of impaired communication with intact consciousness and language.

[locked-in syndrome]

Acute and chronic peripheral and /or central disorders of the voluntary motor system can produce profound paresis or paralysis , at times with ophthalmoplegia , while preserving consciousness and language function . Although at times appearing to be unconscious , these patients are awake and alert but unable to communicate , manipulate their environment , or participate in medical decision-making . Clinicians caring for these patients are ethically tasked with recognizing this clinical reality , enacting measures to facilitate communication , and abiding by ethical and legal principles that support autonomous patient-centered decision-making . This chapter reviews the various disorders that may cause this state while using three exemplary disorders - locked-in syndrome , caused by an anterior pontine lesion ; high cervical spinal cord lesion ; and amyotrophic lateral sclerosis - to discuss the management of these patients .