Skip to main content

Advertisement

Log in

Pain Perception in Disorders of Consciousness: Neuroscience, Clinical Care, and Ethics in Dialogue

  • Original Paper
  • Published:
Neuroethics Aims and scope Submit manuscript

Abstract

Pain, suffering and positive emotions in patients in vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious states (MCS) pose clinical and ethical challenges. Clinically, we evaluate behavioural responses after painful stimulation and also emotionally-contingent behaviours (e.g., smiling). Using stimuli with emotional valence, neuroimaging and electrophysiology technologies can detect subclinical remnants of preserved capacities for pain which might influence decisions about treatment limitation. To date, no data exist as to how healthcare providers think about end-of-life options (e.g., withdrawal of artificial nutrition and hydration) in the presence or absence of pain in non-communicative patients. Here, we aimed to better clarify this issue by re-analyzing previously published data on pain perception (Prog Brain Res 2009 177, 329–38) and end-of-life decisions (J Neurol 2010 258, 1058–65) in patients with disorders of consciousness. In a sample of 2259 European healthcare professionals we found that, for VS/UWS more respondents agreed with treatment withdrawal when they considered that VS/UWS patients did not feel pain (77%) as compared to those who thought VS/UWS did feel pain (59%). This interaction was influenced by religiosity and professional background. For MCS, end-of-life attitudes were not influenced by opinions on pain perception. Within a contemporary ethical context we discuss (1) the evolving scientific understandings of pain perception and their relationship to existing clinical and ethical guidelines; (2) the discrepancies of attitudes within (and between) healthcare providers and their consequences for treatment approaches, and (3) the implicit but complex relationship between pain perception and attitudes toward life-sustaining treatments.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Notes

  1. Patients with locked-in syndrome (LIS) are unable to move body parts, but remain fully conscious of themselves and their environment. In classic cases, LIS patients use their eyes for basic communication with their surroundings (e.g., look up for “yes”, look down for “no”). In cases of complete LIS, patients cannot even move their eyelids and, unless carefully assessed, these patients can be erroneously diagnosed as unconscious [37].

  2. Religiosity was defined as the belief in a personal God belonging to an institutionalized religion (i.e., Christianity, Islam, Judaism) independently of practicing.

References

  1. Ekman, Paul, and Wallace V. Friesen. 1971. Constants across cultures in the face and emotion. Journal of Personality and Social Psychology 17(2): 124–129.

    Article  Google Scholar 

  2. Laureys, Steven, Gastone G. Celesia, François Cohadon, Jan Lavrijsen, Jose Leon-Carrrion, Walter G. Sannita, Leon Sazbon, et al. 2010. Unresponsive wakefulness syndrome: A new name for the vegetative state or apallic syndrome. BMC Medicine 8(1): 68. doi:10.1186/1741-7015-8-68.

    Article  Google Scholar 

  3. Jennett, Bryan, and Fred Plum. 1972. Persistent vegetative state after brain damage. A syndrome in search of a name. Lancet 1(7753): 734–737.

    Article  Google Scholar 

  4. Giacino, Joseph T., Stephen Ashwal, Nancy Childs, Ronald Cranford, Bryan Jennett, Douglas I. Katz, James P. Kelly, et al. 2002. The minimally conscious state: Definition and diagnostic criteria. Neurology 58(3): 349–353.

    Article  Google Scholar 

  5. Bruno, Marie-Aurèlie, Audrey Vanhaudenhuyse, Aurore Thibaut, Gustave Moonen, and Steven Laureys. 2011. From unresponsive wakefulness to minimally conscious PLUS and functional locked-in syndromes: Recent advances in our understanding of disorders of consciousness. Journal of Neurology 258(7): 1373–1384. doi:10.1007/s00415-011-6114-x.

    Article  Google Scholar 

  6. Demertzi, Athena, Caroline Schnakers, Didier Ledoux, Camille Chatelle, Marie-Aurèlie Bruno, Audrey Vanhaudenhuyse, Mélanie Boly, Gustave Moonen, and Steven Laureys. 2009. Different beliefs about pain perception in the vegetative and minimally conscious states: A European survey of medical and paramedical professionals. Progress in Brain Research 177: 329–338. doi:10.1016/S0079-6123(09)17722-1.

    Article  Google Scholar 

  7. Schnakers, Caroline, and Nathan D. Zasler. 2007. Pain assessment and management in disorders of consciousness. Current Opinion in Neurology 20(6): 620–626.

    Article  Google Scholar 

  8. Farisco, Michele. 2011. The ethical pain. Neuroethics:1-12. doi:10.1007/s12152-011-9111-y.

  9. Demertzi, Athena, Audrey Vanhaudenhuyse, Marie-Aurèlie Bruno, Caroline Schnakers, Mélanie Boly, Pierre Boveroux, Pierre Maquet, Gustave Moonen, and Steven Laureys. 2008. Is there anybody in there? Detecting awareness in disorders of consciousness. Expert Review in Neurotherapeutics 8(11): 1719–1730.

    Article  Google Scholar 

  10. The Multi-Society Task Force on PVS. 1994. Medical aspects of the persistent vegetative state (2). The New England Journal of Medicine 330(22): 1572–1579.

    Article  Google Scholar 

  11. Royal College of Physicians. 2003. The vegetative state: Guidance on diagnosis and management. Clinical Medicine 3(3): 249–254.

    Article  Google Scholar 

  12. Cassel, Eric J. 1982. The nature of suffering and the goals of medicine. The New England Journal of Medicine 306(11): 639–645.

    Article  Google Scholar 

  13. Demertzi, Athena, Steven Laureys, and Marie-Aurèlie Bruno. 2011. The ethics in disorders of consciousness. In Annual Update in Intensive Care and Emergency Medicine, ed. J.L. Vincent, 675–682. Berlin: Springer.

    Google Scholar 

  14. Council on Scientific Affairs and Council on Ethical and Judicial Affairs. 1990. Persistent vegetative state and the decision to withdraw or withhold life support. The Journal of the American Medical Association 263(3): 426–430.

    Article  Google Scholar 

  15. Demertzi, Athena, Didier Ledoux, Marie-Aurèlie Bruno, Audrey Vanhaudenhuyse, Olivia Gosseries, Andrea Soddu, Caroline Schnakers, Gustave Moonen, and Steven Laureys. 2011. Attitudes towards end-of-life issues in disorders of consciousness: A European survey. Journal of Neurology 258(6): 1058–1065. doi:10.1007/s00415-010-5882-z.

    Article  Google Scholar 

  16. Wilkinson, Dominic J., Guy Kahane, Malcolm Horne, and Julian Savulescu. 2009. Functional neuroimaging and withdrawal of life-sustaining treatment from vegetative patients. Journal of Medical Ethics 35(8): 508–511. doi:10.1136/jme.2008.029165.

    Article  Google Scholar 

  17. International Association for the Study of Pain. 1994. Classification of Chronic Pain: descriptions of chronic pain syndromes and definitions of pain terms. Task force on taxonomy. Seatle: IASP Press.

    Google Scholar 

  18. Loeser, John D., and Rolf-Detlef Treede. 2008. The Kyoto protocol of IASP basic pain terminology. Pain 137(3): 473–477. doi:10.1016/j.pain.2008.04.025.

    Article  Google Scholar 

  19. Laureys, Steven. 2005. Science and society: Death, unconsciousness and the brain. Nature reviews Neuroscience 6(11): 899–909.

    Article  Google Scholar 

  20. The Medical Task Force on Anencephaly. 1990. The infant with anencephaly. The New England Journal of Medicine 322(10): 669–674.

    Article  Google Scholar 

  21. Payne, S. Kirk, and Robert M. Taylor. 1997. The persistent vegetative state and anencephaly: Problematic paradigms for discussing futility and rationing. Seminars in Neurology 17(3): 257–263.

    Article  Google Scholar 

  22. Halliburton, James R. 1998. Awareness during general anesthesia: New technology for an old problem. CRNA: The Clinical Forum for Nurse Anesthetists 9(2): 39–43.

    Google Scholar 

  23. Schnakers, Caroline, Marie-Elisabeth Faymonville, and Steven Laureys. 2009. Ethical implications: Pain, coma, and related disorders. In Encyclopedia of consciousness, ed. W.P. Banks, 243–250. Oxford: Elsevier.

    Chapter  Google Scholar 

  24. Schnakers, Caroline, Camille Chatelle, Audrey Vanhaudenhuyse, Steve Majerus, Didier Ledoux, Mélanie Boly, Marie-Aurèlie Bruno, et al. 2010. The Nociception Coma Scale: A new tool to assess nociception in disorders of consciousness. Pain 148(2): 215–219. doi:10.1016/j.pain.2009.09.028.

    Article  Google Scholar 

  25. Giacino, Joseph T., Kathleen Kalmar, and John Whyte. 2004. The JFK Coma Recovery Scale-Revised: Measurement characteristics and diagnostic utility. Archives of physical medicine and rehabilitation 85(12): 2020–2029.

    Article  Google Scholar 

  26. Magee, Wendy L. 2005. Music therapy with patients in low awareness states: Approaches to assessment and treatment in multidisciplinary care. Neuropsychological Rehabilitation 15(3–4): 522–536. doi:10.1080/09602010443000461.

    Article  Google Scholar 

  27. Laureys, Steven, and Mélanie Boly. 2008. The changing spectrum of coma. Nature Clinical Practice Neurology 4(10): 544–546.

    Article  Google Scholar 

  28. Laureys, Steven, Fabien Perrin, Marie-Elisabeth Faymonville, Caroline Schnakers, Mélanie Boly, Valerie Bartsch, Steve Majerus, Gustave Moonen, and Pierre Maquet. 2004. Cerebral processing in the minimally conscious state. Neurology 63(5): 916–918.

    Article  Google Scholar 

  29. Schiff, Nicholas D., Diana Rodriguez-Moreno, A. Kamal, K.H. Kim, Joseph T. Giacino, Fred Plum, and Joy Hirsch. 2005. fMRI reveals large-scale network activation in minimally conscious patients. Neurology 64(3): 514–523.

    Article  Google Scholar 

  30. Bekinschtein, Tristan A., Ramon Leiguarda, Jorge Armony, Adrian M. Owen, Silvina Carpintiero, Jorge Niklison, Lisa Olmos, Lucas Sigman, and Facundo F. Manes. 2004. Emotion processing in the minimally conscious state. Journal of Neurology, Neurosurgery, and Psychiatry 75(5): 788.

    Article  Google Scholar 

  31. Zhu, Jianhong, Xuehai Wu, Liang Gao, Ying Mao, Ping Zhong, Weijun Tang, and Liangfu Zhou. 2009. Cortical activity after emotional visual stimulation in minimally conscious state patients. Journal of Neurotrauma 26(5): 677–688. doi:10.1089/neu.2008.0691.

    Article  Google Scholar 

  32. de Jong, Bauke M., Antoon T. Willemsen, and Anne M. Paans. 1997. Regional cerebral blood flow changes related to affective speech presentation in persistent vegetative state. Clinical Neurology and Neurosurgery 99(3): 213–216.

    Article  Google Scholar 

  33. Llinas, Rodolfo, and Urs Ribary. 2001. Consciousness and the brain. The thalamocortical dialogue in health and disease. Annals New York Academy of Sciences 929: 166–175.

    Article  Google Scholar 

  34. Machado, Calixto, Mario Estevez, Joel Gutierrez, Carlos Beltran, Yazmina Machado, Yanin Machado, Mauricio Chinchilla, and Jesus Perez-Nellar. 2011. Recognition of the mom’s voice with an emotional content in a PVS patient. Clinical Neurophysiology 122(5): 1059–1060. doi:10.1016/j.clinph.2010.08.022. author reply 1061-1052.

    Article  Google Scholar 

  35. Riganello, Francesco, Antonio Candelieri, Maria Quintieri, Domenico Conforti, and Giuliano Dolce. 2010. Heart rate variability: An index of brain processing in vegetative state? An artificial intelligence, data mining study. Clinical Neurophysiology 121(12): 2024–2034. doi:10.1016/j.clinph.2010.05.010.

    Article  Google Scholar 

  36. Eickhoff, Simon B., Manuel Dafotakis, Christian Grefkes, Tony Stöcker, N. Jon Shah, Alfons Schnitzler, Karl Zilles, and Mario Siebler. 2008. fMRI reveals cognitive and emotional processing in a long-term comatose patient. Experimental Neurology 214(2): 240–246. doi:10.1016/j.expneurol.2008.08.007.

    Article  Google Scholar 

  37. Laureys, Steven, Frédéric Pellas, Philippe Van Eeckhout, Sofiane Ghorbel, Caroline Schnakers, Fabien Perrin, Jacques Berre, et al. 2005. The locked-in syndrome: What is it like to be conscious but paralyzed and voiceless? Progress in Brain Research 150: 495–511.

    Article  Google Scholar 

  38. Kotchoubey, Boris, Jochen Kaiser, Vladimir Bostanov, Werner Lutzenberger, and Niels Birbaumer. 2009. Recognition of affective prosody in brain-damaged patients and healthy controls: A neurophysiological study using EEG and whole-head MEG. Cognitive, Affective & Behavioral Neuroscience 9(2): 153–167. doi:10.3758/CABN.9.2.153.

    Article  Google Scholar 

  39. Price, Donald D. 2000. Psychological and neural mechanisms of the affective dimension of pain. Science 288(5472): 1769–1772.

    Article  Google Scholar 

  40. Tracey, Irene. 2005. Nociceptive processing in the human brain. Current Opinion in Neurobiology 15(4): 478–487. doi:10.1016/j.conb.2005.06.010.

    Article  Google Scholar 

  41. Vogt, Brent A., Robert W. Sikes, and Leslie J. Vogt. 1993. Anterior cingulate cortex and the medical pain system. In Neurobiology of cingulate cortex and limbic thalamus, ed. Brent A. Vogt and Michael Gabriel, 313–344. Boston: Birkhauser.

    Google Scholar 

  42. Laureys, Steven, Marie-Elisabeth Faymonville, Philippe Peigneux, Pierre Damas, Bernard Lambermont, Guy Del Fiore, Christian Degueldre, et al. 2002. Cortical processing of noxious somatosensory stimuli in the persistent vegetative state. Neuroimage 17(2): 732–741.

    Article  Google Scholar 

  43. Baars, Bernard, Thomas Z. Ramsoy, and Steven Laureys. 2003. Brain, conscious experience and the observing self. Trends in Neurosciences 26(12): 671–675.

    Article  Google Scholar 

  44. Laureys, Steven. 2005. The neural correlate of (un)awareness: Lessons from the vegetative state. Trends in Cognitive Sciences 9(12): 556–559.

    Article  Google Scholar 

  45. Kassubek, Jan, Freimut D. Juengling, Thomas Els, Joachim Spreer, Martin Herpers, Thomas Krause, Ernst Moser, and Carl H. Lucking. 2003. Activation of a residual cortical network during painful stimulation in long-term postanoxic vegetative state: A 15O-H2O PET study. Journal of the Neurological Sciences 212(1–2): 85–91.

    Article  Google Scholar 

  46. Boly, Mélanie, Marie-Elisabeth Faymonville, Caroline Schnakers, Philippe Peigneux, Bernard Lambermont, Christophe Phillips, Patrizio Lancellotti, et al. 2008. Perception of pain in the minimally conscious state with PET activation: An observational study. Lancet Neurology 7(11): 1013–1020.

    Article  Google Scholar 

  47. Boly, Mélanie, Marie-Elisabeth Faymonville, Philippe Peigneux, Bernard Lambermont, François Damas, Andre Luxen, Maurice Lamy, Gustave Moonen, Pierre Maquet, and Steven Laureys. 2005. Cerebral processing of auditory and noxious stimuli in severely brain injured patients: differences between VS and MCS. Neuropsycholigal Rehabilitation 15(3–4): 283–289.

    Article  Google Scholar 

  48. Berridge, Kent, and Morten Kringelbach. 2011. Building a neuroscience of pleasure and well-being. Psychology of Well-Being 1(1): 1–26. doi:10.1186/2211-1522-1-3.

    Google Scholar 

  49. Demertzi, Athena, Olivia Gosseries, Didier Ledoux, Steven Laureys, and Marie-Aurèlie Bruno. in press. Quality of life and end-of-life decisions after brain injury. In Rethinking disability and quality of life: a global perspective, eds. Narelle Warren, and Lenore Manderson. Social Indicators Research Dordrecht: Springer.

  50. Bruno, Marie-Aurèlie, Jan L. Bernheim, Didier Ledoux, Frédéric Pellas, Athena Demertzi, and Steven Laureys. 2011. A survey on self-assessed well-being in a cohort of chronic locked-in syndrome patients: happy majority, miserable minority. British Medical Journal Open:1–9.

  51. Quill, Timothy E. 2005. Terri Schiavo—a tragedy compounded. The New England Journal of Medicine 352(16): 1630–1633.

    Article  Google Scholar 

  52. Racine, Eric, Rakesh Amaram, Matthew Seidler, Marta Karczewska, and Judy Illes. 2008. Media coverage of the persistent vegetative state and end-of-life decision-making. Neurology 71(13): 1027–1032. doi:10.1212/01.wnl.0000320507.64683.ee.

    Article  Google Scholar 

  53. Tresch, Donald D., Farrol H. Sims, Edmund H. Duthie Jr., and Michael D. Goldstein. 1991. Patients in a persistent vegetative state attitudes and reactions of family members. Journal of the American Geriatrics Society 39(1): 17–21.

    Google Scholar 

  54. Platts-Mills, T.F., D.A. Esserman, D.L. Brown, A.V. Bortsov, P.D. Sloane, and S.A. McLean. 2011. Older US emergency department patients are less likely to receive pain medication than younger patients: Results from a national survey. Annals of Emergency Medicine. doi:10.1016/j.annemergmed.2011.09.014.

  55. Fins, Joseph J. 2006. Affirming the right to care, preserving the right to die: Disorders of consciousness and neuroethics after Schiavo. Palliative and Supportive Care 4(2): 169–178.

    Google Scholar 

  56. Ahronheim, Judith C., and M. Rose Gasner. 1990. The sloganism of starvation. Lancet 335(8684): 278–279.

    Article  Google Scholar 

  57. Payne, S.Kirk, Robert M. Taylor, Carol Stocking, and Greg A. Sachs. 1996. Physicians’ attitudes about the care of patients in the persistent vegetative state: A national survey. Annals of Internal Medicine 125(2): 104–110.

    Google Scholar 

  58. Daroff, Robert B. 1990. The American Neurological Association survey results on PVS. Paper presented at the 115th Annual Meeting of the American Neurological Association, Atlanta, GA, October 14-17.

  59. Childs, Nancy L., Walt N. Mercer, and Helen W. Childs. 1993. Accuracy of diagnosis of persistent vegetative state. Neurology 43(8): 1465–1467.

    Article  Google Scholar 

  60. Schnakers, Caroline, Audrey Vanhaudenhuyse, Joseph Giacino, Mandredi Ventura, Mélanie Boly, Steve Majerus, Gustave Moonen, and Steven Laureys. 2009. Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessment. BMC Neurology 9: 35.

    Article  Google Scholar 

  61. Andrews, Keith, Lesley Murphy, Ros Munday, and Clare Littlewood. 1996. Misdiagnosis of the vegetative state: Retrospective study in a rehabilitation unit. British Medical Journal (Clinical Research Ed.) 313(7048): 13–16.

    Article  Google Scholar 

  62. Young, Bryan, Warren Blume, and Abbyann Lynch. 1989. Brain death and the persistent vegetative state: Similarities and contrasts. Canadian Journal of Neurological Sciences 16(4): 388–393.

    Google Scholar 

  63. Youngner, Stuart J., Seth S. Landefeld, Claudia J. Coulton, Barbara W. Juknialis, and Mark Leary. 1989. Brain death and organ retrieval. A cross-sectional survey of knowledge and concepts among health professionals. The Journal of the American Medical Association 261(15): 2205–2210.

  64. Siminoff, Laura A., Christopher Burant, and Stuart J. Youngner. 2004. Death and organ procurement: Public beliefs and attitudes. Kennedy Institute of Ethics Journal 14(3): 217–234.

    Article  Google Scholar 

  65. Asch, David A., Judy A. Shea, M.Kathryn Jedrziewski, and Charles L. Bosk. 1997. The limits of suffering: Critical care nurses’ views of hospital care at the end of life. Social Science and Medicine 45(11): 1661–1668.

    Article  Google Scholar 

  66. Festic, Emir, Michael E. Wilson, Ognjen Gajic, Gavin D. Divertie, and Jeffrey T. Rabatin. 2011. Perspectives of physicians and nurses regarding end-of-life care in the intensive care unit. Journal of Intensive Care Medicine. doi:10.1177/0885066610393465.

  67. Racine, Eric, Marie-Josee Dion, Christine A.C. Wijman, Judy Illes, and Maarten G. Lansberg. 2009. Profiles of neurological outcome prediction among intensivists. Neurocritical Care 11(3): 345–352. doi:10.1007/s12028-009-9225-9.

    Article  Google Scholar 

  68. Randolph, Adrienne G., Mary B. Zollo, Robert S. Wigton, and Timothy S. Yeh. 1997. Factors explaining variability among caregivers in the intent to restrict life-support interventions in a pediatric intensive care unit. Critical Care Medicine 25(3): 435–439.

    Article  Google Scholar 

  69. Rocker, Graeme, Deborah Cook, Peter Sjokvist, Bruce Weaver, Simon Finfer, Ellen McDonald, John Marshall, et al. 2004. Clinician predictions of intensive care unit mortality. Critical Care Medicine 32(5): 1149–1154.

    Article  Google Scholar 

  70. Rebagliato, Marisa, Marina Cuttini, Lara Broggin, István Berbik, Umberto de Vonderweid, Gesine Hansen, Monique Kaminski, et al. 2000. Neonatal end-of-life decision making: Physicians’ attitudes and relationship with self-reported practices in 10 European countries. The Journal of the American Medical Association 284(19): 2451–2459.

    Article  Google Scholar 

  71. Marcin, James P., Murray M. Pollack, Kantilal M. Patel, Bruce M. Sprague, and Urs E. Ruttimann. 1999. Prognostication and certainty in the pediatric intensive care unit. Pediatrics 104(4 Pt 1): 868–873.

    Article  Google Scholar 

  72. Demertzi, Athena, Charlene Liew, Didier Ledoux, Marie-Aurèlie Bruno, Michael Sharpe, Steven Laureys, and Adam Zeman. 2009. Dualism persists in the science of mind. Annals of the New York Academy of Sciences 1157: 1–9.

    Article  Google Scholar 

  73. Jennett, Bryan. 2002. The vegetative state. Medical facts, ethical and legal dilemmas. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  74. Christakis, Nicholas A., and David A. Asch. 1995. Physician characteristics associated with decisions to withdraw life support. American Journal of Public Health 85(3): 367–372.

    Article  Google Scholar 

  75. Sprung, Charles L., Simon L. Cohen, Peter Sjokvist, Mario Baras, Hans-Henrik Bulow, Seppo Hovilehto, Didier Ledoux, et al. 2003. End-of-life practices in European intensive care units: The Ethicus Study. The Journal of the American Medical Association 290(6): 790–797.

    Article  Google Scholar 

  76. Racine, Eric, Catherine Rodrigue, James L. Bernat, Richard Riopelle, and Sam D. Shemie. 2010. Observations on the ethical and social aspects of disorders of consciousness. The Canadian Journal of Neurological Sciences 37(6): 758–768.

    Google Scholar 

  77. Stumpf, Samuel E. 1986. A comment on “Helen”. Southern Medical Journal 79(9): 1057–1058.

    Article  Google Scholar 

  78. Ropper, Allan H. 2010. Cogito ergo sum by MRI. The New England Journal of Medicine 362(7): 648–649. doi:10.1056/NEJMe0909667.

  79. Kahane, Guy, and Julian Savulescu. 2009. Brain damage and the moral significance of consciousness. The Journal of Medicine and Philosophy 34(1): 6–26. doi:10.1093/jmp/jhn038.

  80. Singer, Peter. 2011. Practical Ethics. Third Ed. Cambridge: Cambridge University Press.

  81. Veatch, Robert M. 2005. The death of whole-brain death: The plague of the disaggregators, somaticists, and mentalists. The Journal of Medicine and Philosophy 30(4): 353–378. doi:10.1080/03605310591008504.

    Google Scholar 

  82. Fletcher, Joseph. 1979. Humanhood: Essays in biomedical ethics. New York: Prometheus Books.

    Google Scholar 

  83. Macklin, Ruth 1983. Personhood in the bioethics literature. The Milbank Memorial Fund quarterly. Health and Society 61(1): 35–57.

  84. Racine, Eric, Ofek Bar-Ilan, and Judy Illes. 2005. fMRI in the public eye. Nature Reviews Neuroscience 6(2): 159–164. doi:10.1038/nrn1609.

    Article  Google Scholar 

  85. Glannon, Walter 2009. Our brains are not us. Bioethics 23(6): 321–329. doi:10.1111/j.1467-8519.2009.01727.x.

    Google Scholar 

  86. Racine, Eric, Sarah Waldman, Jarett Rosenberg, and Judy Illes. 2010. Contemporary neuroscience in the media. Social Science and Medicine 71(4): 725–733. doi:10.1016/j.socscimed.2010.05.017.

    Article  Google Scholar 

  87. McCabe, David P., and Alan D. Castel. 2008. Seeing is believing: The effect of brain images on judgments of scientific reasoning. Cognition 107(1): 343–352. doi:10.1016/j.cognition.2007.07.017.

    Article  Google Scholar 

  88. O’Connell, Garret, Janet De Wilde, Jane Haley, Kirsten Shuler, Burkhard Schafer, Peter Sandercock, and Joanna M. Wardlaw. 2011. The brain, the science and the media. The legal, corporate, social and security implications of neuroimaging and the impact of media coverage. EMBO Reports 12(7): 630–636. doi:10.1038/embor.2011.115.

    Article  Google Scholar 

  89. Weisberg, Deena Skolnick, Frank C. Keil, Joshua Goodstein, Elizabeth Rawson, and Jeremy R. Gray. 2008. The seductive allure of neuroscience explanations. Journal of Cognitive Neuroscience 20(3): 470–477. doi:10.1162/jocn.2008.20040.

    Article  Google Scholar 

Download references

Acknowledgments

This research was funded by the Belgian National Funds for Scientific Research (FNRS), the European Commission, the James McDonnell Foundation, the Mind Science Foundation, the French Speaking Community Concerted Research Action (ARC-06/11-340), the Public Utility Foundation “Université Européenne du Travail”, “Fondazione Europea di Ricerca Biomedica” and the University and University Hospital of Liège. Writing of this paper was also supported by the Canadian Institutes of Health Research (New Investigator Award and Operating grant). We would also like to thank Dr. Emily Bell for helpful feedback on a previous version of this manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A. Demertzi.

Additional information

A. Demertzi and E. Racine contributed equally to the manuscript.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Demertzi, A., Racine, E., Bruno, MA. et al. Pain Perception in Disorders of Consciousness: Neuroscience, Clinical Care, and Ethics in Dialogue. Neuroethics 6, 37–50 (2013). https://doi.org/10.1007/s12152-011-9149-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12152-011-9149-x

Keywords

Navigation