Knowledge of Partial Awareness in Disorders of Consciousness: Implications for Ethical Evaluations?

Friedrich, Orsolya

doi:10.1007/s12152-011-9145-1

Cited by 6 publications

(5 citation statements)

References 33 publications

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“…The literature includes a wide range of papers, from those which just raise the issue briefly to those which provide more detailed discussions (Bernat 2010; Fins 2010). Scholarship has been approached from a legal angle (Eisenberg 2008; Bressman and Reidler 2010; Fisher and Appelbaum 2010) and a philosophical perspective (Friedrich 2013). Some has provided a cautionary note.…”

Section: Commentary On the Use Of Fmri Technology From Within The Anamentioning

confidence: 99%

Relative Values: Perspectives on a Neuroimaging Technology From Above and Within the Ethical Landscape

et al. 2016

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In this paper we contribute to Bsociology in bioethics^and help clarify the range of ways sociological work can contribute to ethics scholarship. We do this using a case study of an innovative neurotechnology, functional magnetic resonance imaging, and its use to attempt to diagnose and communicate with severely brain-injured patients. We compare empirical data from interviews with relatives of patients who have a severe brain injury with perspectives from mainstream bioethics scholars. We use the notion of an Bethical landscape^as an analogy for the different ethical positions subjects can take-whereby a person's position relative to the landscape makes a difference to the way they experience and interact with it. We show that, in comparison to studying abstract ethics Bfrom above^the ethical landscape, which involves universal generalizations and global judgements, studying ethics empirically Bfrom the ground,^within the ethical landscape foregrounds a more plural and differentiated picture. We argue it is important not to treat empirical ethics as secondary to abstract ethics, to treat on-the-ground perspectives as useful only insofar as they can inform ethics from above. Rather, empirical perspectives can illuminate the plural vantage points in ethical judgments, highlight the Blived^nature of ethical reasoning, and point to all ethical vantage points as being significant. This is of epistemic importance to normative ethics, since researchers who pay attention to the various positions in and trajectories through the ethical landscape are unlikely to think about ethics in terms of abstract agency-as can happen with top-down ethics-or to elide agency with the agency of policymakers. Moreover, empirical perspectives may have transformative implications for people on the ground, especially where focus on the potential harms and benefits they face brings their experiences and interests to the forefront of ethical and policy discussion.

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Section: Commentary On the Use Of Fmri Technology From Within The Anamentioning

confidence: 99%

Relative Values: Perspectives on a Neuroimaging Technology From Above and Within the Ethical Landscape

et al. 2016

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“…6,103,104 Indeed, patients in VS condition, and the uncertainty about their state of awareness along with decisions about life-sustaining treatment, have often been the focus of media attention 105 and ethical debates. 106 As it is stated by Mappes, 107 “recognizing prospective autonomy in the context of a living will or establishing a substituted judgment is always necessary when a patient is no longer able to declare his or her current wishes”. In this context, if one considers “personal identity” and a “living will” existing only when certain states of consciousness are present (as the findings of the present study seem to imply), then establishing a substituted judgment (the will of the patient is determined by a family member or a doctor) on this basis could make sense.…”

Section: Conclusion and Clinical And Ethical Significancementioning

confidence: 99%

“…Furthermore, knowledge of possible awareness can influence the contact behavior of family members: they may, for example, feel more compelled to directly address their noncomunicative relative if signs of awareness could be demonstrated through some neuroimaging technology where clinical signs are absent. 106…”

Section: Conclusion and Clinical And Ethical Significancementioning

confidence: 99%

Dissociation of Vegetative and Minimally Conscious Patients Based on Brain Operational Architectonics

Fingelkurts

Bagnato

et al. 2013

Clin EEG Neurosci

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Discrimination between patients in vegetative (VS) and minimally conscious state (MCS) is currently based upon the behavioral gold standard. Behavioral assessment remains equivocal and difficult to interpret as evidence for the presence or absence of consciousness, resulting in possible clinical misdiagnosis in such patients. Application of an operational architectonics (OA) strategy to electroencephalogram (EEG) analysis reveals that absence of consciousness in patients in VS is paralleled by significant impairment in overall EEG operational architecture compared to patients in MCS: neuronal assemblies become smaller, their life span shortened, and they became highly unstable and functionally disconnected (desynchronized). However, in a previous study, patients with different brain damage etiologies were intermixed. Therefore, the goal of the present study was to investigate whether the application of OA methodology to EEG could reliably dissociate patients in VS and MCS independent of brain damage etiology. We conclude that the observed EEG OA structure impairment in patients in VS and partial preservation in patients in MCS is a marker of consciousness/unconsciousness rather than physiological damage. Results of this study may have neuroscientific, clinical, and ethical implications.

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“…[32]). Additionally, the clarity about the physical actual potentiality of having self-awareness can affect how the patient's family members behave toward the patient: they might, for example, feel more motivated and compelled to address their noncommunicative relative directly if signs of Selfhood could be demonstrated using some neuroimaging technology even when clinical signs are absent (see also [33]).…”

Section: Introductionmentioning

confidence: 99%

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

Fingelkurts¹,

Fingelkurts²

2023

J. Integr. Neurosci.

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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)

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Knowledge of Partial Awareness in Disorders of Consciousness: Implications for Ethical Evaluations?

Cited by 6 publications

References 33 publications

Relative Values: Perspectives on a Neuroimaging Technology From Above and Within the Ethical Landscape

Relative Values: Perspectives on a Neuroimaging Technology From Above and Within the Ethical Landscape

Dissociation of Vegetative and Minimally Conscious Patients Based on Brain Operational Architectonics

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

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