Tracing Uncertainties in New Prognostics of Consciousness

Resumé

Uncertainty is a basic condition of medicine - in research, in the clinic and in the intersection between the two domains. Prognostics is in its very nature an attempt to address and manage the uncertainty of the future. New technologies are continuously developed in order to make prognostics more precise and hence make the future more predictable. However, such technologies may not always serve to decrease uncertainty, but rather enhance or introduce new uncertainties, and thereby open other futures than those imagined. Our study follows an interdisciplinary Danish research group currently seeking to advance methods of neuroimaging in prognostics for unresponsive patients with uncertain consciousness due to anoxic brain injury after an out-of-hospital cardiac arrest. Applying an interdisciplinary approach combining ethnographic methods and philosophical analysis we trace the experience of uncertainty in this context of tool development at the intersection of scientific and clinical reasoning around disorders of consciousness. Specifically, we employ and develop the three-dimensional framework of uncertainty developed by Han, Klein and Arora (2011). We identify salient uncertainties from the perspective of the researchers and show how these lead to different uncertainties experienced by the clinicians. Additionally, we show that while ambiguity may be the source of different kinds of uncertainty, the context determines the nature of the source. Our investigation has a descriptive and theoretical focus, however, uncovering these details may serve as a basis for normative discussions of strategies for uncertainty management, as well as evidence evaluation in research and the clinic in the future.