The unconscious deserves moral attention

Pär SegerdahlLast autumn, Michele Farisco wrote one of the most read posts on The Ethics Blog. The post was later republished by BioEdge.

Today, I want to recommend a recent article where Farisco develops his thinking – read it in the journal, Philosophy, Ethics, and Humanities in Medicine.

The article will certainly receive at least as much attention as the blog post did. Together with Kathinka Evers, Farisco develops a way of thinking about the unconscious that at first seems controversial, but which after careful consideration becomes increasingly credible. That combination is hard to beat.

What is it about? It is about patients with serious brain injuries, perhaps after a traffic accident. Ethical discussions about these patients usually focus on residual consciousness. We think that there is an absolute difference between consciousness and unconsciousness. Only a conscious person can experience well-being. Only a conscious person can have interests. Therefore, a patient with residual consciousness deserves a completely different care than an unconscious patient. A different attention to pain relief, peace and quiet, and stimulation. – Why create a warm and stimulating environment if the patient is completely unaware of it?

In the article, Farisco challenges the absolute difference between consciousness and unconsciousness. He describes neuroscientific evidence that indicates two often-overlooked connections between conscious and unconscious brain processes. The first is that the unconscious (at least partly) has the abilities that are considered ethically relevant when residual consciousness is discussed. The other connection is that conscious and unconscious brain processes are mutually dependent. They shape each other. Even unconsciously, the brain reacts uniquely to the voices of family members.

Farisco does not mean that this proves that we have an obligation to treat unconscious patients as conscious. However, the unconscious deserves moral attention. Perhaps we should strive to assess also retained unconscious abilities. In some cases, we should perhaps play the music the patient loved before the accident.

Pär Segerdahl

Farisco, M. and Evers, K. The ethical relevance of the unconscious. Philosophy, Ethics, and Humanities in Medicine (2017) DOI 10.1186/s13010-017-0053-9

This post in Swedish

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