Few things bother me more than when I see someone talking past a patient as if they are not there. Some of the most profound conversations I’ve ever had took place with a person who lacked the capacity to respond. When my girlfriend’s father was comatose, I knelt at his deathbed and asked for his daughter’s hand in marriage. When I informed a patient with dementia about a critical medical decision, I looked her in the eyes as I spoke. And every morning when I pre-rounded on unresponsive patients in the ICU, I greeted them warmly and told them what I was doing.
I believe a fundamental aspect of being a doctor is recognizing and appreciating every patient’s unique humanity and treating them with respect. This extends especially to patients who may not be able to respond. If you are meeting a patient for the first time, it is pure arrogance to assume you can guess their level of awareness accurately enough to discount their potential fears, and even for patients in whom you have a high degree of certainty about their capacity, it is better to err on the side of kindness than indifference. In practice, this means that no matter what the situation is, you always ask (or inform if the situations warrant it) the patient when you would like to ask their caregiver questions, and you always speak to them respectfully no matter the situation. It also means that when appropriate you explain what you are doing to their body (telling them you are about to insert an IV, or that you are taking them down to surgery) rather than just subjecting them to it.
When treating patients who seem to lack the capacity to respond, I always imagine what it would be like to have perfect awareness yet lack the ability to express myself. Then I ask myself how I would like to be treated in that situation and try to make that the way in which I behave every time.