Contemplating on the Nature of Selfhood in DoC Patients: Neurophenomenological Perspective

Abstract

Medical well-regarded policy recommendations for patients with disorders of consciousness (DoC) are almost exclusively relied on behavioural examination and evaluation of higher-order cognition, and largely disregard the patients' self. This is so because practically establishing the presence of self-awareness or Selfhood is even more challenging than evaluating the presence of consciousness. At the same time, establishing the potential (actual physical possibility) of Selfhood in DoC patients is crucialy important from clinical, ethical, and moral standpoints because Selfhood is the most central and private evidence of being an independent and free agent that unites intention, embodiment, executive functions, attention, general intelligence, emotions and other components within the intra-subjective frame (first-person givenness). The importance of Selfhood is supported further by the observation that rebooting of self-awareness is the first step to recovery after brain damage. It seems that complex experiential Selfhood can be plausibly conceptualized within the Operational Architectonics (OA) of brain-mind functioning and reliably measured by quantitative electroencephalogram (qEEG) operational synchrony.Keywords: disorders of consciousness (DoC); selfhood; self-consciousness; quantitative electroencephalogram (qEEG); first-person givenness; operational synchrony; brain; vegetative state (VS); minimally conscious state (MCS); unresponsive wakefulness syndrome (UWS)

Psychedelics and disorders of consciousness: the current landscape and the path forward

“…2015 ). Since DoC patients are unable to report (by whatever means), there is little to no information about the phenomenology of these patients ( Fingelkurts and Fingelkurts 2023 ). When observing the difference in complexity between UWS and MCS, the latter has higher complexity compared to the former reflecting the ‘minimal’ conserved level of consciousness ( Casarotto et al.…”

Patients with Disorders of Consciousness: Are They Nonconscious, Unconscious, or Subconscious? Expanding the Discussion

“…While this approach is very helpful in delineating the border-zone states of phenomenal consciousness and separating the unconscious from the nonconscious processes in patients with DoC, the information about personal identity or experiential selfhood of patients is not readily accessible at this level of analysis and description. At the same time, it is precisely because of the experiential selfhood that we are able to comprehend the ethical and moral significance of what makes life worth living [6] (see also [1,2,7]), as only a self-conscious being can have preferences regarding how its life goes, something that gives the being an interest in continuing to live [2]. Hence, clarity on the presence of first-person phenomenology and the sense of agency of selfhood is needed for patients with DoC and their families.…”

“…Particularly pertinent are the questions of how to detect and respect autonomy and a sense of agency of the personhood when the capacities that constitute autonomy and agency are themselves disordered, as they usually are in patients with DoC [1,6]. Such questions are not a trivial or academic curiosity but rather an important inquiry as some theorists have argued that states of diminished or absent consciousness may preclude attribution of a 'full moral status' or the experience of 'life worth living' to patients classified as having DoC [2,7,8].…”

“…Expectations of poor consciousness recovery and associated attributions of therapeutic futility typically underlie the decision to discontinue life-sustaining treatment [23]. This highlights how important consciousness/unconsciousness boundary is to the idea of personhood/selfhood and to what makes life worth living [1,6]. Increased awareness of these issues and clarity regarding terminology are particularly timely given the recent urgent need to maximize ethically responsible care in this population of patients.…”

Self-processing in coma, unresponsive wakefulness syndrome and minimally conscious state

“…In the context of non-communicative patients, it is useful to know whether they respond (cerebrally and/or behaviorally) to their own name. Indeed, the presence of such a response means that he/she can detect or discriminate a self-referential stimulus, i.e., an item of the environment that refers to her/him ( Fingelkurts and Fingelkurts, 2023 ). Its presence suggests not only the preservation of one aspect of the self but also a possible perspective taking, i.e., meta-representations of mental and bodily states as one’s own mental and bodily states ( Vogeley and Fink, 2003 ).…”