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- Diane Coleman, D. Alan Shewmon & J. T. Giacino (2002). "The Minimally Conscious State: Definition and Diagnostic Criteria": Comments and Reply. Neurology 58 (3):506-507.
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This article defends two theses: that a mental state is conscious if and only if it has phenomenal character, i.e., if and only if there is something it is like for the subject to be in that state, and that all state consciousness involves self-consciousness, in the sense that a mental state is conscious if and only if its possessor is, in some suitable way, conscious of being in it. Though neither of these theses is novel, there is a dearth of direct arguments for them in the scholarly literature and the relationship between them has so far gone underrecognized. This article attempts to remedy this lack, advancing the claim that if all conscious states have phenomenal character, then all state consciousness involves self-consciousness.
Disorders of consciousness include coma, the vegetative state and the minimally conscious state. Such patients are often regarded as unconscious. This has consequences for end of life decisions for these patients: it is much easier to justify withdrawing life support for unconscious than conscious patients. Recent brain imaging research has however suggested that some patients may in fact be conscious.
The value of resting electroencephalogram (EEG) in revealing neural constitutes of consciousness (NCC) was examined. We quantified the dynamic repertoire, duration and oscillatory type of EEG microstates in eyes-closed rest in relation to the degree of expression of clinical self-consciousness. For NCC a model was suggested that contrasted normal, severely disturbed state of consciousness and state without consciousness. Patients with disorders of consciousness were used. Results suggested that the repertoire, duration and oscillatory type of EEG microstates in resting condition quantitatively related to the level of consciousness expression in brain-damaged patients and healthy-conscious subjects.
Specifically, results demonstrated that (a) decreased number of EEG microstate types was associated with altered states of consciousness, (b) unawareness was associated with the lack of diversity in EEG alpha-rhythmic microstates, and (c) the probability for the occurrence and duration of delta-, theta- and slow-alpha-rhythmic microstates were associated with unawareness, whereas the probability for the occurrence and duration of fast-alpha-rhythmic microstates were associated with consciousness. In conclusion, resting EEG has a potential value in revealing NCC. This work may have implications for clinical care and medical–legal decisions in patients with disorders of consciousness.
Recent progress in neurosciences has improved our understanding of chronic disorders of consciousness. One example of this advancement is the emergence of the new diagnostic category of minimally conscious state (MCS). The central characteristic of MCS is impaired consciousness. Though the phenomenon now referred to as MCS pre-existed its inclusion in diagnostic classifications, the current medical ethical concepts mainly apply to patients with normal consciousness and to non-conscious patients. Accordingly, how we morally should stand with persons in minimally conscious state remains unclear. In this paper, I examine whether the notion of human dignity could provide us with guidance with the moral difficulties MCS gives rise to. More precisely, I focus on the question of whether we are justified in holding that persons in minimally conscious state possess human dignity.
Discussion of Diane Coleman , D. Alan Shewmon & J. T. Giacino, "The minimally conscious state: Definition and diagnostic criteria": Comments and reply
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