Current research on the neural basis of consciousness is based mainly on neuroimaging, physiology and psychophysics. This target article reviews what is known about biochemical factors that may contribute to the development of consciousness, based on loss of consciousness (i.e., coma). There are two theories of the biochemical mode of action of general anaesthetics. One is that anaesthesia is a direct (i.e., not receptor-mediated) effect of the anaesthetic on cellular neurophysiological function; the other is that some alteration of receptor function (...) occurs. General anaesthetics are mainly GABA agonists but some (such as ketamine) are glutamate antagonists. They also affect other systems, particularly cholinergic ones. There are various comas of metabolic origin. For example, a combination of small doses of the iron chelators desferrioxamine and prochlorperazine induce a profound and long lasting coma in humans. The mechanisms that might mediate this include redox mechanisms at the glutamate synapse, post-synaptic endocytosis of dopamine and iron, and intracellular iron-dopamine complexes, which are powerful dismuters of the superoxide anion. New findings in cell biology relating to endocytosis and recycling of receptors are discussed in a wider context. These biochemical events may induce coma by two mechanisms: (i) Consciousness may depend on widespread cortical (or cortico-thalamic) activation. (ii) Whereas these biochemical changes are widespread, only the changes in a subset of consciousness' neurons may count. An experimental program to distinguish between these two alternatives is proposed. (shrink)
Following coma, some patients will recover wakefulness without signs of consciousness (only showing reflex movements, i.e., the vegetative state) or may show non-reflex movements but remain without functional communication (i.e., the minimally conscious state). Currently, there remains a high rate of misdiagnosis of the vegetative state (Schnakers et. al. BMC Neurol, 9:35, 8) and the clinical and electrophysiological markers of outcome from the vegetative and minimally conscious states remain unsatisfactory. This should incite clinicians to use multimodal assessment to detect objective (...) signs of consciousness and validate para-clinical prognostic markers in these challenging patients. This review will focus on advanced magnetic resonance imaging (MRI) techniques such as magnetic resonance spectroscopy, diffusion tensor imaging, and functional MRI (fMRI studies in both “activation” and “resting state” conditions) that were recently introduced in the assessment of patients with.. (shrink)
In this article I contend that the tendency to equate coma with anencephalia is a mistake. A key idea here is that there is a type of "mental-state" predicate that is applicable to the comatose but not to anencephalics. One of the moral implications of this is that the concept of "brain death", its alleged popularity notwithstanding, is badly confused. Also, because anencephalics have no mental life, there are few moral grounds for hesitating to use anencephalics as organ donors.
Herbert, Michael Clinicians are beginning to understand the varied outcomes following severe brain injury, one of which is post-coma unresponsiveness (PCU). However, much still needs to be done to fully comprehend this elusive state. Current clinical knowledge is outlined below.
McGovern, Kevin This article reviews three statements from the National Health and Medical Research Council on post-coma unresponsiveness (PCU). One of the functions of the NHMRC is to propose standards and guidelines for health care in Australia. The paper explores the causes and neuropathology of PCU, imaging and other tests and prognosis from unresponsiveness.
The prospect, in terms of subjective expectations, of immortality under the no-collapse interpretation of quantum mechanics is certain, as pointed out by several authors, both physicists and, more recently, philosophers. The argument, known as quantum suicide, or quantum immortality, has received some critical discussion, but there hasn't been any questioning of David Lewis's point that there is a terrifying corollary to the argument, namely, that we should expect to live forever in a crippled, more and more damaged state, that barely (...) sustains life. This is the prospect of eternal quantum torment. Based on some empirical facts, I argue for a conclusion that is much more reassuring than Lewis's terrible scenario.1. (shrink)
In the care of patients with disorders of consciousness (DOC), some ethical difficulties stem from the challenges of accurate diagnosis and the uncertainty of prognosis. Current neuroimaging research on these disorders could eventually improve the accuracy of diagnoses and prognoses and therefore change the context of end-of-life decision making. However, the perspective of healthcare professionals on these disorders remains poorly understood and may constitute an obstacle to the integration of research. We conducted a qualitative study involving healthcare professionals from an (...) acute care university medical center. A short questionnaire captured demographic data as well as the experience of participants with DOC patients. A semi-structured interview was used to explore attitudes toward ethical issues identified in a previous literature review. Qualitative content analysis of interviews was conducted with the NVivo software. Accurate diagnosis among DOC is often regarded as a challenge, but this was generally not the case for our participants because most reported high confidence in DOC diagnoses. However, participants reported struggling with prognosis, especially because of its essential role for end-of-life decision making and communication with families. Variability of opinion between healthcare professionals was reported and identified by some as a minor issue while others stressed how families struggle with different medical opinions. End-of-life decision making encompassed a large proportion of ethical challenges in these patients, and the removal of artificial nutrition and hydration created significant discomfort in a minority of participants. The concept of futility was subject to wide-ranging understandings with both favorable and unfavorable opinions. Our data suggest that to ensure the incorporation of new evidence-based advances, attention should be directed to the real-world practices and challenges of accurate diagnosis and prognosis. Given pervasive challenges in end-of-life care, we recommend improved training of healthcare professionals in the care of patients with DOC, particularly in end-of life care, understanding the context of decision making, and determining how to optimally integrate new neuroscience research on the care of patients with DOC. (shrink)
The case of Terri Schiavo, a young woman who spent 15 years in a persistent vegetative state, has emerged as a watershed in debates over end-of-life care. While many observers had thought the right to refuse medical treatment was well established, this case split a family, divided a nation, and counfounded physicians, legislators, and many of the people they treated or represented. In renewing debates over the importance of advance directives, the appropriate role of artificial hydration and nutrition, and the (...) responsibilities of family members, the case also became one of history's most extensively litigated health care disputes. The Case of Terri Schiavo assembles a team of first-hand participants and content experts to provide thoughtful and nuanced analyses. In addition to a comprehensive overview, the book includes contributions by Ms. Schiavo's guardian ad litem, a neurologist and lawyer who participated in the case, and scholars who examine issues related to litigation, faith, gender, and disability. The volume also includes a powerful dissent from the views of many scholars in the bioethics community. The book is intended for students, health care professionals, policy makers, and other in search of carefully reasoned analyses of the case that will shape our view of death and end-of-life medical care for decades. (shrink)
One reason why the Biological Approach to personal identity is attractive is that it doesn’t make its advocates deny that they were each once a mindless fetus.[i] According to the Biological Approach, we are essentially organisms and exist as long as certain life processes continue. Since the Psychological Account of personal identity posits some mental traits as essential to our persistence, not only does it follow that we could not survive in a permanently vegetative state or irreversible coma, but it (...) would appear that none of us was ever a mindless fetus. But what happens to the organism that was a mindless fetus when the _person_ arrives on the scene?[ii] Can the acquisition of thought destroy an organism? That would certainly be news to biologists. Does one organism cease to exist with the emergence of thought and another organism, one identical to the person, take its place? (Burke,1994) That doesn’t seem much more plausible than the previous move. Should identity and Leibniz. (shrink)
Defenders of the Psychological Approach to Personal Identity (PAPI) insist that the possession of some kind of mind is essential to us. We are essentially thinking beings, not living creatures. We would cease to exist if our capacity for thought was irreversibly lost due to a coma or permanent vegetative state. However, the onset of such conditions would not mean the death of an organism. It would survive in a mindless state. But this would appear to mean that before the (...) loss of cognition and the destruction of the person, the organism and the person were spatially coincident entities – two beings composed of the same matter at the same time and place. Perhaps the most problematic aspect of positing spatially coincident material entities is that it would seem to result in there being one too many thinkers. Since the person can obviously think, the organism should also have such a capacity as a result of possessing the same brain as well as every other atom of the person. This means that there now exist two thinking beings under the reader’s clothes! (shrink)
: Although "brain death" and the dead donor rule—i.e., patients must not be killed by organ retrieval—have been clinically and legally accepted in the U.S. as prerequisites to organ removal, there is little data about public attitudes and beliefs concerning these matters. To examine the public attitudes and beliefs about the determination of death and its relationship to organ transplantation, 1351 Ohio residents ≥18 years were randomly selected and surveyed using random digit dialing (RDD) sample frames. The RDD telephone survey (...) was conducted using computer-assisted telephone interviews. The survey instrument was developed from information provided by 12 focus groups and a pilot study of the questionnaire. Three scenarios based on hypothetical patients were presented: "brain dead," in a coma, or in a persistent vegetative state (PVS). Respondents provided personal assessments of whether the patient in each scenario was dead and their willingness to donate that patient's organs in these circumstances. More than 98 percent of respondents had heard of the term "brain death," but only one-third (33.7%) believed that someone who was "brain dead" was legally dead. The majority of respondents (86.2%) identified the "brain-dead" patient in the first scenario as dead, 57.2 percent identified the patient in a coma as dead (Scenario 2), and 34.1 percent identified the patient in a PVS as dead (Scenario 3). Nearly one-third (33.5%) were willing to donate the organs of patients they classified as alive for at least one scenario, in seeming violation of the dead donor rule. Most respondents were not willing to violate the dead donor rule, although a substantial minority was. However, the majority of respondents were unaware, misinformed, or held beliefs that were not congruent with current definitions of "brain death." This study highlights the need for more public dialogue and education about "brain death" and organ donation. (shrink)
Coma, vegetative state, lock-in syndrome and akinetic mutism are defined. Vegetative state is a state with no evidence of awareness of self or environment and showing cycles of sleep and wakefulness. PVS is an operational definition including time as a variable. PVS is a vegetative state that has endured or continued for at least one month. PVS can be diagnosed with a reasonable amount of medical certainty; however, the diagnosis of PVS must be kept separate from the outcome. The patient (...) outcome can be predicted based on etiology and age. Using outcome probabilities and etiology as criteria, patients can be subdivided in 5 groups and reasonable management guidelines can be suggested. Three levels of care can be provided to PVS patients: high technology, supportive and compassionate care. Pragmatic options for the various subgroups of patients are suggested. Management decisions will remain difficult for both the family and the health-care team. The role of the physician in these difficult cases is to share the decision-making with the family. (shrink)
: Research by Siminoff and colleagues reveals that many lay people in Ohio classify legally living persons in irreversible coma or persistent vegetative state (PVS) as dead and that additional respondents, although classifying such patients as living, would be willing to procure organs from them. This paper analyzes possible implications of these findings for public policy. A majority would procure organs from those in irreversible coma or in PVS. Two strategies for legitimizing such procurement are suggested. One strategy would be (...) to make exceptions to the dead donor rule permitting procurement from those in PVS or at least those who are in irreversible coma while continuing to classify them as living. Another strategy would be to further amend the definition of death to classify one or both groups as deceased, thus permitting procurement without violation of the dead donor rule. Permitting exceptions to the dead donor rule would require substantial changes in law—such as authorizing procuring surgeons to end the lives of patients by means of organ procurement—and would weaken societal prohibitions on killing. The paper suggests that it would be easier and less controversial to further amend the definition of death to classify those in irreversible coma and PVS as dead. Incorporation of a conscience clause to permit those whose religious or philosophical convictions support whole-brain or cardiac-based death pronouncement would avoid violating their beliefs while causing no more than minimal social problems. The paper questions whether those who would support an exception to the dead donor rule in these cases and those would support a further amendment to the definition of death could reach agreement to adopt a public policy permitting organ procurement of those in irreversible coma or PVS when proper consent is obtained. (shrink)
The main goal of Brain Death and Disorders of Consciousness is to provide a suitable scientific platform to discuss all topics related to human death and coma.
(1) Most commonly these terms are used to describe people. People and other creatures are conscious if they are awake and responsive to sensory stimulation. Because this is a property of creatures, we can call it creature consciousness. An individual lacks such consciousness if it is asleep, in a coma, anesthetized, and so forth. Creature consciousness demands a mainly biological explanation, as against an explanation in mainly psychological terms.
A new diagnostic system for organic psychiatry is presented. We first define "organic psychiatry", and then give the theoretical basis for conceiving organic psychiatric disorders in terms of hypothetical psychopathogenetic processes, HPP:s. Such hypothetical disorders are not strictly identical to the clusters of symptoms in which they typically manifest themselves, since the symptoms may be concealed or modified by intervening factors in non typical circumstances and/or in the simultaneous presence of several disorders. The six basic disorders in our system are (...) Astheno Emotional Disorder (AED), Somnolence Sopor Coma Disorder (SSCD), Hallucination Coenestopathy Depersonalisation Disorder (HCDD), Confusional Disorder (CD), Emotional Motivational Blunting Disorder (EMD) and Korsakoff's Amnestic Disorder (KAD). We describe their usual etiologies, their typical symptoms and course, and some forms of interaction between them. (shrink)
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.
In this paper, the problem of correct ascriptions of consciousness to patients in neurological intensive care medicine is explored as a special case of the general philosophical other minds problem. It is argued that although clinical ascriptions of consciousness and coma are mostly based on behavioral evidence, a behaviorist epistemology of other minds is not likely to succeed. To illustrate this, the so-called total locked-in syndrome, in which preserved consciousness is combined with a total loss of motor abilities due to (...) a lower ventral brain stem lesion, is presented as a touchstone for behaviorism. It is argued that this example of consciousness without behavioral expression does not disprove behaviorism specifically, but rather illustrates the need for a non-verificationist theory of other minds. It is further argued that a folk version of such a theory already underlies our factual ascriptions of consciousness in clinical contexts. Finally, a non-behaviorist theory of other minds for patients with total locked-in syndrome is outlined. (shrink)
Wijdicks and colleagues1 recently presented the Full Outline of UnResponsiveness (FOUR) scale as an alternative to the Glasgow Coma Scale (GCS)2 in the evaluation of consciousness in severely brain-damaged patients. They studied 120 patients in an intensive care setting (mainly neuro-intensive care) and claimed that “the FOUR score detects a locked-in syndrome, as well as the presence of a vegetative state.”1 We fully agree that the FOUR is advantageous in identifying locked-in patients given that it specifically tests for eye movements (...) or blinking on command. This is welcomed given that misdiagnosis of the locked-in syndrome has been shown to occur in more than half of the cases (see Laureys and colleagues3 for review). As for the diagnosis of the vegetative state, the scale explicitly tests for visual pursuit, and hence can disentangle the vegetative state from the minimally conscious state (MCS). The diagnostic criteria for MCS have been proposed4 only recently, but Wijdicks and colleagues1 do not mention the existence of this clinical entity in their article. As for the vegetative state, MCS can be encountered in the acute or subacute setting as a transitional state on the way to further recovery, or it can be a more chronic or even permanent condition. The MCS refers to patients showing inconsistent, albeit clearly discernible, minimal behavioral evidence of consciousness (eg, localization of noxious stimuli, eye fixation or tracking, reproducible movement to command, or nonfunctional verbalization).4 The FOUR scale does not test for all of the behavioral criteria required to diagnose MCS.4 It is known from the literature (see Majerus and colleagues5 for review) that about a third of patients diagnosed with vegetative state are actually in MCS, and this misdiagnosis can lead to major clinical, therapeutic, and ethical consequences. We tested the ability of the newly proposed FOUR scale to correctly diagnose the vegetative state in an acute (intensive care and neurology ward) and chronic (neurorehabilitation) setting.. (shrink)
Some patients awaken from their coma but only show reflex motor activity. This condition of wakeful (eyes open) unawareness is called the vegetative state. In 2002, a new clinical entity coined ‘‘minimally conscious state’’ defined patients who show more than reflex responsiveness but remain unable to communicate their thoughts and feelings. Emergence from the minimally conscious state is defined by functional recovery of verbal or nonverbal communication.1 Our empirical medical definitions aim to propose clearcut borders separating disorders of consciousness such (...) as coma, vegetative state and minimally conscious state but clinical reality shows that these boundaries can often be fuzzy (fig 1). Recent clinical, electrophysiological and neuroimaging studies are shedding light on these challenging limits of consciousness encountered following severe acute brain damage. At the patient’s bedside, it is very challenging to differentiate reflex or automatic motor behaviour from movements indicating signs of consciousness, and hence some minimally conscious patients might be misdiagnosed as being vegetative. For some motor responses (eg, blinking to visual threat, brief fixation, normal flexion response to pain, etc) it remains unclear whether they truly are voluntary or willed because we lack convincing scientific evidence. We also lack consensus on how to practically assess some of these behavioural responses. For example, there is no agreement on what stimulus to employ in the assessment of visual pursuit movements— often one of the first clinical signs heralding the transition from the vegetative to the minimally conscious state. Vanhaudenhuyse and colleagues2 recently studied visual pursuit in 51 post-comatose patients comparing eye tracking of a moving object, person or mirror. It was shown that more.. (shrink)
Objectives: Recent fMRI studies have shown that it is possible to reliably identify the defaultmode network (DMN) in the absence of any task, by resting-state connectivity analyses in healthy volunteers. We here aimed to identify the DMN in the challenging patient population of disorders of consciousness encountered following coma. Experimental design: A spatial independent component analysis-based methodology permitted DMN assessment, decomposing connectivity in all its different sources either neuronal or artifactual. Three different selection criteria were introduced assessing anticorrelation-corrected connectivity with (...) or without an automatic masking procedure and calculating connectivity scores encompassing both spatial and temporal properties. These three methods were validated on 10 healthy controls and applied to an independent group of 8 healthy controls and 11 severely brain-damaged patients [locked-in syndrome (n ¼ 2), minimally conscious (n ¼ 1), and vegetative state (n ¼ 8)]. Principal observations: All vegetative patients showed fewer connections in the default-mode areas, when compared with controls, contrary to locked-in patients who showed nearnormal connectivity. In the minimally conscious-state patient, only the two selection criteria considering both spatial and temporal properties were able to identify an intact right lateralized BOLD connectivity pattern, and metabolic PET data suggested its neuronal origin. Conclusions: When assess-. (shrink)
This paper deals with Wittgenstein's statement that our "craving for generality" is a main source of confusion in philosophy. It is argued that difficulties connected with this tendency also affect most attempts to explain or elaborate Wittgenstein's philosophical thinking, since most commentaries elucidate his thinking in general terms, in the notions and classificatory apparatus of some prevalent vocabulary of professional philosophy. It is argued that this craving for generality is closely tied up with another tendency of traditional philosophy, namely the (...) tendency to impose substantive normative claims. The effort to dissociate himself from this tendency is a main feature of the late Wittgenstein's philosophy that has not been sufficiently observed. /// O presente ensaio trata da afirmação de Wittgenstein segundo a qual "a nossa ânsia de generalidade" constitui umafonte principal de confusão em filosofia. O autor procura demonstrar até que ponto dificuldades ligadas a esta tendência tambem afectam a maior parte das tentativas para explicar ou pormenorizar o pensamento filosófico de Wittgenstein, dado que a maiorparte dos comentdrios elucidam o seu pensamento em termos gerais, com as noqoes e aparato classificatorio de certo vocabulário dominante dafilosofia profissional. O artigo mostra assim coma está ânsia da generalidade está intimamente ligada com outra tendencia dafilosofia tradicional, nomeadamente a tendência a impor reivindicações normativas substantivas. O autor considera que o esforço de Wittgenstein para se dissociar desta tendencia é precisamente uma das características principais da sua filosofia tardia que não tern sido suficientemente estudada. (shrink)
It is worthwhile comparing Hylomorphic and Animalistic accounts of personal identity since they both identify the human animal and the human person.The topics of comparison will be three: The first is accounting for our intuitions in cerebrum transplant and irreversible coma cases. Hylomorphism, unlike animalism, appears to capture “commonsense” beliefs here, preserves the maxim that identity matters, and does not run afoul of the Only x and y rule. The next topic of comparison reveals how the rival explanations of transplants (...) and comas are both at odds with some compelling biological assumptions. The third issue deals with our practical concerns, most notably, the possibility of an afterlife. It turns out that the hylomorphic treatment of Purgatory raises the spectra of the “too many thinkers” problem and some considerable unfairness. Contrary to expectations, an animalist insistence on uninterrupted bodily continuity between this life and the next does not involve deceptive body snatching. (shrink)
Carbon monoxide (CO) intoxication leads to acute and chronic neurological deficits, but little is known about the specific noxious mechanisms. 1 H magnetic resonance spectroscopy (MRS) may allow insight into the pathophysiology of CO poisoning by monitoring neurochemical disturbances, yet only limited information is available to date on the use of this protocol in determining the neurological effects of CO poisoning. To further examine the short-term and long-term effects of CO on the (...) central nervous system, we have studied seven patients with CO poisoning assessed by gray and white matter MRS, magnetic resonance imaging (MRI) and neuropsychological testing. Five patients suffered from acute high-dose CO intoxication and were in coma for 1–6 days. In these patients, MRI revealed hyperintensities of the white matter and globus pallidus and also showed increased choline (Cho) and decreased N -acetyl aspartate (NAA) ratios to creatine (Cr), predominantly in the white matter. Lactate peaks were detected in two patients during the early phase of high-dose CO poisoning. Two patients with chronic low-dose CO exposure and without loss of consciousness had normal MRI and MRS scans. On follow-up. five of our seven patients had long-lasting intellectual impairment, including one individual with low-dose CO exposure. The MRS results showed persisting biochemical alterations despite the MRI scan showing normalization of morphological changes. In conclusion, the MRS was normal in patients suffering from chronic low-dose CO exposure; in contrast, patients with high-dose exposure showed abnormal gray and white matter levels of NAA/Cr, Cho/Cr and lactate, as detected by 1 H MRS, suggesting disturbances of neuronal function, membrane metabolism and anaerobic energy metabolism, respectively. Early increases in Cho/Cr and decreases of NAA/Cr may be related to a poor long-term outcome, but confirmation by future studies is needed. (shrink)
Until comparatively recently, say the middle of the last century, spinal cord injury was fatal as pressure sores and other infections took their toll. Those with severe brain injuries, unable to move or even communicate, fared even worse; without movement or feeding such patients were nursed until nature took its course. Over the last few decades medical and nursing advances have enabled some of these vegetative patients to survive for considerable time, provoking, at times, ethical and legal dilemmas. Though they (...) survived, without overt behaviour or clear communication their carers were frequently unsure how much residual function remained. Now real progress is occurring in this area thanks to the application of neuro-scientific methods by some outstanding groups of workers. Subjects with severe brain injury may begin in complete, unresponsive coma but then ‘lighten’ to one of three categories. In vegetative state (VS), patients are apparently awake but without evidence of voluntary behaviour and have no apparent awareness of self or environment, whilst in minimally conscious state (MCS) patients have some behaviour beyond the reflex but are not able to communicate effectively. These conditions usually result from widespread brain damage at either or both cortical and subcortical levels due to injury or anoxia, though they can also be seen in end stage neurological conditions like Alzheimer’s. In locked in syndrome (LIS), patients ‘awake’ from coma, usually due to stroke, aware of their surroundings and their situation but unable to speak or move, beyond eye lid control and eye movement. For many, LIS will be recognised from Bauby’s extraordinary account in ‘The Diving Bell and the Butterfly,’ though, incidentally, it was presaged in Samuel Beckett’s novella ‘The Unnameable.’ LIS reflects a profound disconnection between brain and body, except for the upper cranial nerves involved in eyelid movement. The overriding question is how much awareness these patients have.. (shrink)
Background Evidence concerning how Japanese physicians think and behave in specific clinical situations that involve withholding or withdrawal of medical interventions for end-of-life or frail elderly patients is yet insufficient. Methods To analyze decisions and actions concerning the withholding/withdrawal of life-support care by Japanese physicians, we conducted cross-sectional web-based internet survey presenting three scenarios involving an elderly comatose patient following a severe stroke. Volunteer physicians were recruited for the survey through mailing lists and medical journals. The respondents answered questions concerning (...) attitudes and behaviors regarding decision-making for the withholding/withdrawal of life-support care, namely, the initiation/withdrawal of tube feeding and respirator attachment. Results Of the 304 responses analyzed, a majority felt that tube feeding should be initiated in these scenarios. Only 18% felt that a respirator should be attached when the patient had severe pneumonia and respiratory failure. Over half the respondents felt that tube feeding should not be withdrawn when the coma extended beyond 6 months. Only 11% responded that they actually withdrew tube feeding. Half the respondents perceived tube feeding in such a patient as a "life-sustaining treatment," whereas the other half disagreed. Physicians seeking clinical ethics consultation supported the withdrawal of tube feeding (OR, 6.4; 95% CI, 2.5–16.3; P < 0.001). Conclusion Physicians tend to harbor greater negative attitudes toward the withdrawal of life-support care than its withholding. On the other hand, they favor withholding invasive life-sustaining treatments such as the attachment of a respirator over less invasive and long-term treatments such as tube feeding. Discrepancies were demonstrated between attitudes and actual behaviors. Physicians may need systematic support for appropriate decision-making for end-of-life care. (shrink)
The will is one of the three pillars of the trilogy of mind that has pervaded Western thought for millennia, the other two being affectivity and cognition (Hilgard 1980). In the past century, the concept of will was imperceptibly replaced by the cognitive-oriented behavioral qualifiers “voluntary,” “goal-directed,” “purposive,” and “executive” (Tranel et al. 1994), and has lost much of its heuristic merits, which are related to the notion of “human autonomy” (Lhermitte 1986). We view catatonia as the clinical expression of (...) impairment of the brain mechanisms that promote human will. Catatonia is to the brain systems engaged in will, as coma is to the reticular ascending systems that promote sleep and wakefulness (Plum 1991). (shrink)
Objective: The value of spontaneous EEG oscillations in distinguishing patients in vegetative and minimally conscious states was studied. Methods: We quantified dynamic repertoire of EEG oscillations in resting condition with closed eyes in patients in vegetative and minimally conscious states (VS and MCS). The exact composition of EEG oscillations was assessed by the probability-classification analysis of short-term EEG spectral patterns. Results: The probability of delta, theta and slow-alpha oscillations occurrence was smaller for patients in MCS than for VS. Additionally, only (...) patients in MCS demonstrated fast-alpha oscillation occurrence. Depending on the type and composition of EEG oscillations, the probability of their occurrence was either aetiology dependent or independent. The probability of EEG oscillations occurrence differentiated brain injuries with different aetiologies. Conclusions: Spontaneous EEG oscillations have a potential value in distinguishing patients in VS and MCS. Significance: This work may have implications for clinical care, rehabilitative programs and medical–legal decisions in patients with impaired consciousness states following coma due to acute brain injuries. (shrink)
Praise for Ethics in Psychotherapy and Counseling, Third Edition "This is absolutely the best text on professional ethics around. . . . This is a refreshingly open and inviting text that has become a classic in the field." —Derald Wing Sue, professor of psychology, Teachers College, Columbia University "I love this book! And so will therapists, supervisors, and trainees. In fact, it really should be required reading for every mental health professional and aspiring professional. . . . And it is (...) a fun read to boot!" —Stephen J. Ceci, H. L. Carr Professor of Psychology, Cornell University "Pope and Vasquez have done it again. . . . an indispensable resource for seasoned professionals and students alike." —Beverly Greene, professor of psychology, St. John's University "[The third edition] focuses on how to think about ethical dilemmas . . . with empathy for the decision-maker whose best option may have to be a compromise between different values. If there is only room on the shelf for one book in the genre, this is it." —Patrick O'Neill, former president, Canadian Psychological Association "This third edition of the classic ethics text provides invaluable resources and enables readers to engage in critical thinking in order to make their own decisions.?This superb reference belongs in every psychology training program's curriculum and on every psychologist's?bookshelf." —Lillian Comas-Diaz, 2006 president, APA Division of Psychologists in Independent Practice "Ken Pope and Melba Vasquez are right on target once again in the third edition, a book that every practicing mental health professional should read and have in their reference library." —Jeffrey N. Younggren, risk management consultant, American Psychological Association Insurance Trust "Without a doubt, this is the definitive book on ethics within psychology that can inform students, educators, clinical researchers, and practitioners." —Nadine J. Kaslow, professor, Department of Psychiatry and Behavioral Science, Emory University School of Medicine "This stunningly good book . . . should be on every therapist's desk for quick reference." —David Barlow, professor of psychology and psychiatry, Boston University. (shrink)
The study of academic plagiarism among university students is at an embryonic stage in Spain and in the other Spanish-speaking countries. This article reports the results of a research, carried out in a medium-sized Spanish university, based on a double method approach—quantitative and qualitative—concerning the factors associated with academic plagiarism from the students’ perspective. The main explanatory factors of the phenomenon, according to the results obtained, are: a) aspects and behaviour of students (bad time management, personal shortcomings when preparing assignments, (...) the elevated number of assignments to be handed in, etc.); b) the opportunities conferred by information and communication technologies to locate, copy and paste information; and, finally, c) aspects related to professors-lecturers and/or the characteristics of the subject-course (lecturers who show no interest in their work, eminently theoretical subjects and assignments, etc.). (shrink)
