Beyond awareness: the need for a more comprehensive ethics of disorders of consciousness

October 23, 2017

Michele FariscoDisorders of consciousness like coma, unresponsive wakefulness syndrome, and what is known as minimally conscious state, are among the most challenging issues in current ethical debates. Ethical analyses of these states usually focus on the ‘residual’ awareness that these patients might still have. Such awareness is taken to have bearing on other factors that are usually considered ethically central, like the patients’ well-being.

Yet, when we take a look at recent scientific investigations of mental activity it appears that things are much more complicated than usually thought. Cognitive science provides empirical evidence that the unconscious brain is able to perform almost all the activities that we (wrongly) think are exclusive of consciousness, including enjoying positive emotions and disregarding negative ones. To illustrate, people that are subliminally exposed to drawings of happy or sad faces are emotionally conditioned in their evaluation of unknown objects, like Chinese characters for people who don’t know Chinese. If preceded by subliminal happy faces, these characters are more likely to elicit positive feelings when consciously perceived. This means that unconscious emotions exist, and these emotions are (plausibly) positive or negative. This in turn suggests that consciousness is not required to have emotions.

Accordingly, people with disorders of consciousness could also have unconscious emotions. Even though they are not capable of external behavior from which we could infer the presence of positive or negative emotional life, we cannot rule out the possibility that these patients’ residual brain activity is related to a residual unaware emotional life, which can be either positive or negative.

We should try to avoid becoming biased by the sort of “consciousness-centrism” that impedes us from seeing the total landscape: there is a lot going on behind (and beyond) the eyes of our awareness.

What does this imply for the ethics of caring for and interacting with people affected by severe disorders of consciousness? Well, as previously said, the ethical discourse surrounding the care for and the relationship with these people has usually focused on their residual awareness, scrutinizing whether and to what extent these people could consciously experience good and bad feelings. Yet if it is possible to have these experiences at the unaware level, shouldn’t this be a relevant consideration when engaging in an ethical analysis of patients with disorders of consciousness? In other words, shouldn’t we take care of their residual unconsciousness in addition to their residual consciousness?

I believe we need to enlarge the scope of our ethical analyses of patients with disorders of consciousness, or at least acknowledge that focusing on residual consciousness is not all we should do, even if it is all we presently can do.

Michele Farisco

Winkielman P., Berridge K.C. Unconscious emotion. Current Directions in Psychological Science. 2004;13(3):120-3

We challenge habits of thought : the Ethics Blog

Interview with Kathinka Evers

June 5, 2012

One of my colleagues here at CRB, Kathinka Evers, recently returned from Barcelona, where she participated in the lecture series, The Origins of the Human Mind:

PS: Why did you participate in this series?

KE: I was invited by the Centre for Contemporary Culture to present the rise of neuroethics and my views on informed materialism.

PS: Why were you invited to talk on these issues?

KE: My last book was recently translated into Spanish (Quando la materia se despierta), and it has attracted interest amongst philosophers and neuroscientists in the Spanish speaking world. In that book, I extend a materialist theory of mind, called “informed materialism,” to neuroethical perspectives, discussing, for example, free will, self-conceptions and personal responsibility.

PS: In a previous blog post I commented upon Roger Scruton’s critical attitude to neuroscientific analyses of subjects that traditionally belong to the social and human sciences. What’s your opinion on his criticism?

KE: Contemporary neuroscience can enrich numerous areas of social science. But the reverse is also true. The brain is largely the result of socio-cultural influences. Understanding the brain also involves understanding its embodiment in a social context. The social and neurobiological perspectives dynamically interact in our development of a deeper understanding of the human mind, of consciousness, and of human identity.

PS: Do you mean that the criticism presupposes a one-sided view of the development of neuroscience?

KE: I suspect that the criticism is not well-informed, scientifically, since it fails to take this neuro-cultural symbiosis into account. But it is not uncommon for philosophers to take a rather defensive position against neuroscientific attempts to enter philosophical domains.

PS: Was this tension noticeable at the meeting in Barcelona?

KE: Not really. Rather, the debate focused on how interdisciplinary collaborations have at last achieved what the theoretical isolationism of the twentieth century – when philosophy of mind was purely a priori and empirical brain science refused to study consciousness – failed to achieve: the human brain is finally beginning to understand itself and its own mind.

Kathinka Evers has developed a course in neuroethics and is currently drafting a new book (in English) on brain and mind.

Pär Segerdahl

We transgress disciplinary borders - the Ethics Blog

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