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The Value and Disvalue of Consciousness

Published online by Cambridge University Press:  16 September 2016

WALTER GLANNON
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Abstract:

Consciousness defines us as persons. It allows us to have both pleasurable and painful experiences. I present four neurological conditions in the clinical setting to explore how consciousness can be beneficial or harmful to patients: intraoperative awareness, prolonged disorders of consciousness, locked-in syndrome, and the effects of narcotics and sedation on terminally ill patients. The ethical significance of consciousness for patients in these conditions depends on two factors: the content of one’s experience and whether one can report this content to others. I argue that the value or disvalue of phenomenal consciousness, what it is like to be aware, may depend on its relation to access consciousness, the ability to report or communicate the content of awareness. Phenomenal consciousness can have disvalue when one wants or expects to be unconscious. It can also have disvalue in the absence of access consciousness because it can allow the patient to experience pain and suffer. Technology that enabled neurologically compromised patients to reliably communicate their experience and wishes could benefit and prevent harm to them. More generally, the neurological conditions I discuss raise the question of when and in what respects consciousness is preferable to unconsciousness.

Keywords

consciousnessunconsciousnessintraoperative awarenessminimally conscious statevegetative statelocked-in syndromepain controlsedation
Type
Articles
Information
Cambridge Quarterly of Healthcare Ethics , Volume 25 , Special Issue 4: Clinical Neuroethics , October 2016 , pp. 600 - 612
Copyright
Copyright © Cambridge University Press 2016 

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References

Notes

1. Posner, J, Saper, C, Schiff, N, Plum, F. Plum and Posner’s Diagnosis of Stupor and Coma. 4th ed. New York: Oxford University Press; 2007.Google Scholar

2. Hochberg, L, Cudkowicz, M. Locked in, but not out? Neurology 2014;82:1852–3.CrossRefGoogle Scholar

3. Laureys, S, Owen, A, Schiff, N. Brain function in coma, vegetative state and related disorders. Lancet Neurology 2004;3:537–46.CrossRefGoogle ScholarPubMed See also Bernat J. The natural history of chronic disorders of consciousness. Neurology 2010;75:206–7; Giacino J, Ashwal S, Childs N, Cranford R, Jennett B, Katz D, et al. The minimally conscious state: definition and diagnostic criteria. Neurology 2002;58:349–53; and Laureys S, Boly M. Unresponsive wakefulness syndrome. Archives Italiennes de Biologie 2012;150:31–5.

4. Alkire, M, Hudetz, A, Tononi, G. Consciousness and anesthesia. Science 2008;322:876–80.CrossRefGoogle ScholarPubMed

5. Crick, F, Koch, C. A framework for consciousness. Nature Neuroscience 2003;6(2):119–26.CrossRefGoogle ScholarPubMed

6. Dehaene, S, Changeux, J-P. Experimental and theoretical approaches to conscious processing. Neuron 2011;70:200–27.CrossRefGoogle ScholarPubMed

7. Tononi, G, Koch, C. The neural correlates of consciousness: An update. Annals of the New York Academy of Sciences 2008;1124:239–61.CrossRefGoogle ScholarPubMed

8. Block N. On a confusion about a function of consciousness. Behavioral and Brain Sciences 1995;18:227–87, at 227 and Block N. Consciousness, accessibility and the mesh between psychology and neuroscience. Behavioral and Brain Sciences 2007;30:481–99.

9. Levy, N. The importance of awareness. Australasian Journal of Philosophy 2013;91:211–29.CrossRefGoogle Scholar

10. Avidan, M, Jacobsohn, M, Glick, D, Burnside, B, Zhang, L, Villafranca, A, et al. Prevention of intraoperative awareness in a high-risk surgical population. New England Journal of Medicine 2011;365:591–600.CrossRefGoogle Scholar

11. Wolpaw, J, Wolpaw, E. Brain-Computer Interfaces: Principles and Practice. New York: Oxford University Press; 2012.CrossRefGoogle Scholar

12. Luaute, J, Maucort-Boulch, L, Tell, F, Quelard, T, Sarraf, J, Iwaz, D, et al. Long-term outcomes of chronic minimally conscious and vegetative states. Neurology 2010;75:246–52.CrossRefGoogle ScholarPubMed

13. Owen, A, Coleman, M, Boly, M, Davis, M, Laureys, S, Pickard, J. Detecting awareness in the vegetative state. Science 2006;313:1402.CrossRefGoogle ScholarPubMed

14. Kahane, G, Savulescu, J. Brain damage and the moral significance of consciousness. Journal of Medicine and Philosophy 2009;34:6–26.Google Scholar See also Wilkinson D, Savulescu J. Is it better to be minimally conscious than vegetative? Journal of Medical Ethics 2013;39:557–8; and Schnakers C. What is it like to be in a disorder of consciousness? In Sinnott-Armstrong W, ed. Finding Consciousness: The Neuroscience, Ethics and Law of Severe Brain Injury. Oxford: Oxford University Press; 2016, at chap. 6.

15. Boly, M, Faymonville, M-E, Schnakers, C, Peigneux, P, Lambermont, B, Phillips, C, et al. Perception of pain in the minimally conscious state with PET activation: An observational study. Lancet Neurology 2008;7:1013–20.CrossRefGoogle ScholarPubMed

16. Fins, J. Rights Come to Mind: Brain Injury, Ethics, and the Struggle for Consciousness. New York: Cambridge University Press; 2015, at 163.CrossRefGoogle ScholarPubMed

17. Cited by Fins in Rights Come to Mind; see note 16, Fins 2015, at 273–4.

18. Schiff, N, Giacino, T, Kalmar, C, Victor, J, Baker, K, Gerber, M, et al. Behavioral improvement with thalamic stimulation after severe traumatic brain injury. Nature 2007;448:600–3.CrossRefGoogle Scholar

19. Monti, M, Vanhaudenhuyse, A, Coleman, M, Boly, M, Pickard, J, Pshibanda, S, et al. Willful modulation of brain activity in disorders of consciousness. New England Journal of Medicine 2010;362:579–89.CrossRefGoogle ScholarPubMed

20. Magrassi, L, Maggioire, G, Pistarini, C, Perri, C, Bastianello, S, Antonio, G, et al. Results on the effects of thalamic stimulation in minimally conscious and vegetative patients. Journal of Neurosurgery 2016 Jan 8:e15700 [online publication].CrossRefGoogle Scholar

21. Royal College of Physicians (UK). Prolonged Disorders of Consciousness: National Clinical Guidelines. Report of a Working Party; 2013, at 9; available at https://www.rcplondon.ac.uk/guidelines-policy/prolonged-disorders-consciousness-national-clinical-guidelines (last accessed 15 Jan 2016).

22. See note 16, Fins 2015, at 168.

23. W v M. EWHC 2433 UK (Fam). 2011.

24. See note 2, Hochberg, Cudkowicz 2014, at 1853.

25. Birbaumer, N, Murguialday, A, Cohen, L. Brain-computer interfaces in paralysis. Current Opinion in Neurology 2008;21:634–8;CrossRefGoogle ScholarPubMed and Birbaumer N, Gallegos-Ayala G, Wildgruber M, Silvoni S, Soekadar S. Direct brain control and communication in paralysis. Brain Topography 2014;27:4–11.

26. Report on the right-to-die case of LIS patient Tony Nicklinson. Guardian 2012 Aug; available at http://theguardian.com/uk/2012/aug/22/tony-nicklinson-right-to-die-case (last accessed 15 Jan 2016).

27. Cited by Griffin, J. Well-Being: Its Meaning, Measurement, and Moral Importance. Oxford: Clarendon Press; 1986, at 8.Google Scholar

28. Benedetti, F. Placebo Effects: Understanding the Mechanisms in Health and Disease. New York: Oxford University Press; 2008.CrossRefGoogle Scholar