Prognosticating of patients in coma: towards a responsible practice

Prognosis of outcome of patients in coma after cardiac arrest is crucial for decision making on (continuation of) treatment. Recent research has shown that visual classification of continuous EEG enables ultra-early, high quality prognosis of poor outcome within 24 hours. This technological innovation, in particular when translated in a quantitative index, may deepen existing controversies with regard to expected quality of life of surviving patients. It may also aggravate tensions between personal values (life of relatives) and societal concerns (cost reduction). Finally, introduction of EEG-based technology enabling ultra-early prognostication may create new controversies regarding timing of the prognosis and subsequent decision making. This project aims to develop the EEG-based prognostic technology in such a way that it contributes to good prognostic practice for comatose patients after cardiac arrest, and thus can be considered a responsible innovation. It explores how EEG-enabled prognosis might affect values in care for comatose patients, comparing the Netherlands, the USA and Germany. A mixture of qualitative (ethical ethnography, interviews) and quantitative methods (stated preference survey) is used. Subsequently, the project investigates by way of stakeholder workshops and normative analysis which conditions need to be satisfied to ensure that introducing EEG-monitoring is ethically and socially desirable. The ultimate aim is to embed these conditions in the material (hard- and software) and the social components (clinical practice, regulation) of prognostic practice, using methods derived from value sensitive design. Finally, the usefulness of the insights gained for innovation of coma prognostics and responsible innovation more generally will be explored.