Misdiagnosis as an ethical and scientific challenge

Abstract

Difficulties of behavioral assessment of consciousness. An  astonishingly  high  rate  of misdiagnosis between vegetative state/unresponsive wakefulness syndrome and minimally conscious state has been detected. This raises the issue of the adequacy of the  consciousness’ assessment in patients with disorders of consciousness. The behavioral  assessment of consciousness could be not able to detect covert awareness, which is increasingly identified by the instrumental assessment.
Ancillary methods. Neurotechnology, particularly neuroimaging, provides relevant data  concerning the neurological underlying condition of patients with DOCs, but the instrumental approach has still to assess some technical issues.
Ethical considerations. A correct diagnosis of a DOC is not only an instrumental issue,  but also an ethically relevant demand to the scientific community. Finally, an integration  between behavioral and instrumental assessments seems to be the most adequate strategy in order to decrease the rate of misdiagnosis.