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Summary The vegetative state (VS) and coma are categorized as disorders of consciousness. Both are states of unconsciousness, in which patients are defined as being unaware; the VS is a state of wakeful unconsciousness, in which patients experience sleep/wake cycles, which distinguishes it from coma. It has long been suspected that the rate of misdiagnosis in the VS is as high as 40%. That is, ~40% of patients diagnosed as unconsciousness may in fact be conscious. Recent neuroscientific developments, particularly in functional neuroimaging, have identified patients who are functionally locked in, unable to respond behaviorally, but able to wilfully modulate their brain activity to indicate that they are conscious. This has resulted in an effort to rename the VS as Unresponsive Wakefulness Syndrome (UWS), both to more accurately describe the condition, and to remove the stigma and negative associations of the term "vegetative" (and the pejorative "vegetable").The key ethical issues with VS and Coma are the right to die and the value of life in a state of unconsciousness, along with ancillary questoins about precedent autonomy. Other ethical issues include the high rate of misdiagnosis, controversy concerning the concept of brain-based "behavior," and questions about quality of life and the best interests of unconscious persons.
Key works After years of clinical neglect and nihilism, a veritable explosion of research into disorders of consciousness in recent years has prompted considerable bioethical debate, as well as reconsideration of key concepts in consciousness studies. Capron provides an overview of the issues and debates here (Capron 1991). Shewmon interrogates the concept of the vegetative state (Shewmon 2004) here; Stins and Laureys (Stins & Laureys 2009); Monti et al (Monti et al 2010), and Owen et al (Owen et al 2007) discuss the ramifications of brain-based "behavior" and the detection of covert consciousness through functional imaging paradigms. Brukamp ( Brukamp 2013) considers whether a new right attaches to patients with disorders of consciousness, in light of recent neuroscientific evidence: a right to the right diagnosis. Panksepp considers the status of the "mind" in the VS (Panksepp et al 2007); and Levy&Savulescu evaluate the moral significance of phenomenal consciousness in ethical debates.
Introductions Knight 2008; Jox & Kuehlmeyer 2013; Jennett 2006; Goodman 2009; Illes & Sahakian 2011.
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  1. added 2020-01-22
    Perception of Social Support Among Family Caregivers of Vegetative Patients: A Qualitative Study.Esmat Noohi, Hamid Peyrovi, Zahra Imani Goghary & Majid Kazemi - 2016 - Consciousness and Cognition 41:150-158.
  2. added 2019-10-31
    Are the Irreversibly Comatose Still Here? The Destruction of Brains and the Persistence of Persons.Lukas J. Meier - 2020 - Journal of Medical Ethics 46 (2):99-103.
    When an individual is comatose while parts of her brain remain functional, the question arises as to whether any mental characteristics are still associated with this brain, that is, whether the person still exists. Settling this uncertainty requires that one becomes clear about two issues: the type of functional loss that is associated with the respective profile of brain damage and the persistence conditions of persons. Medical case studies can answer the former question, but they are not concerned with the (...)
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  3. added 2019-06-06
    Medically Assisted Nutrition and Hydration: The Vegetative State and Beyond: Articles.Jeffrey P. Bishop & Elliott Louis Bedford - 2011 - Christian Bioethics 17 (2):97-104.
  4. added 2019-06-06
    Specific and Nonspecific Thalamocortical Functional Connectivity in Normal and Vegetative States.Jingsheng Zhou, Xiaolin Liu, Weiqun Song, Yanhui Yang & Zhilian Zhao - 2011 - Consciousness and Cognition 20 (2):257-268.
    Recent theoretical advances describing consciousness from information and integration have highlighted the unique role of the thalamocortical system in leading to integrated information and thus, consciousness. Here, we examined the differential distributions of specific and nonspecific thalamocortical functional connections using resting-state fMRI in a group of healthy subjects and vegetative-state patients. We found that both thalamic systems were widely distributed, but they exhibited different patterns. Nonspecific connections were preferentially associated with brain regions involved in higher-order cognitive processing, self-awareness and introspective (...)
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  5. added 2019-06-06
    Paper: The Right to Die in the Minimally Conscious State.L. Syd M. Johnson - 2011 - Journal of Medical Ethics 37 (3):175-178.
    The right to die has for decades been recognised for persons in a vegetative state, but there remains controversy about ending life-sustaining medical treatment for persons in the minimally conscious state. The controversy is rooted in assumptions about the moral significance of consciousness, and the value of life for patients who are conscious and not terminally ill. This paper evaluates these assumptions in light of evidence that generates concerns about quality of life in the MCS. It is argued that surrogates (...)
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  6. added 2019-06-06
    The Development and Nature of the Ordinary\Textfractionsolidus{}Extraordinary Means Distinction in the Roman Catholic Tradition.Scott M. Sullivan - 2007 - Bioethics 21 (7):386-397.
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  7. added 2019-06-06
    PVS and the Terri Schiavo Case: A Reply to Brad Mellon.Gary Fuller - 2007 - Journal of Philosophical Research 32 (Supplement):299-303.
    Brad Mellon argues that persistent-vegetative-state cases, including the recent Terri Schiavo case, are ambiguous. By this he seems to mean that decisions about such cases are fraught with doubt and uncertainty and perhaps even that rational resolution of many such cases is impossible. Faced with such cases the most we can do is to live and cope with the ambiguity. I am more optimistic. With good will, and much clarification and discussion, rational agreement is possible in these cases, including the (...)
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  8. added 2019-06-06
    Tube Feedings and Persistent Vegetative State Patients: Ordinary or Extraordinary Means?Peter Clark - 2006 - Christian Bioethics 12 (1):43-64.
    This article looks at the late John Paul II's allocution on artificial nutrition and hydration (ANH) and the implications his statement will have on the ordinary-extraordinary care distinction. The purpose of this article is threefold: first, to examine the medical condition of a persistent vegetative state (PVS); second, to examine and analyze the Catholic Church's tradition on the ordinary-extraordinary means distinction; and third, to analyze the ethics behind the pope's recent allocution in regards to PVS patients as a matter of (...)
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  9. added 2019-06-06
    Nutrition and Hydration: An Analysis of the Recent Papal Statement in the Light of the Roman Catholic Bioethical Tradition.Thomas Shannon - 2006 - Christian Bioethics 12 (1):29-41.
    This article discuses the unexpectedly firm stance professed by John Paul II on the provision of artificial nutrition and hydration to patients who are in a persistent vegetative state, and its implications on previously held standards of judging medical treatments. The traditional ordinary/extraordinary care distinction is assessed in light of complexities of the recent allocution as well as its impact on Catholic individuals and in Catholic health care facilities. Shannon concludes that the papal allocution infers that the average Catholic patient (...)
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  10. added 2019-06-06
    Reflections on the Papal Allocution Concerning Care for Persistent Vegetative State Patients.Kevin O'Rourke - 2006 - Christian Bioethics 12 (1):83-97.
    This article critically examines the recent papal allocution on patients in a persistent vegetative state with regard to the appropriate conditions for considering “reformable statements.” In the first part of the article, the purpose and meaning of the allocution are assessed. O'Rourke concludes that given consideration of the individual patient's best interest, prolonging artificial nutrition and hydration is not, in every case, the best option. Although he stresses favorability for preservation of the life of the patient through artificial nutrition and (...)
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  11. added 2019-06-06
    The Patient in a Persistent Vegetative State An Ethical Re-Appraisal.P. Schotsmans - 1993 - Bijdragen 54 (1):2-18.
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  12. added 2019-06-06
    Editor's Introduction: Family Privacy and Persistent Vegetative State.Larry Gostin - 1989 - Journal of Law, Medicine and Ethics 17 (4):295-297.
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  13. added 2019-06-05
    Terri Schiavo and the Language of Biopolitics.Sarah K. Hansen - 2012 - International Journal of Feminist Approaches to Bioethics 5 (1):91-112.
    On March 18, 2005, the U.S. House of Representative’s Committee on Government Reform issued subpoenas to Florida residents Michael and Terri Schiavo. The subpoenas summoned the Schiavos to “testify” before the committee regarding its investigation into “treatment options provided to incapacitated patients to advance the[ir] quality of life” (U.S. H.R. 1332, 2005). In light of Terri Schiavo’s long and well-known traumas, many observers questioned the sensitivity of the order for testimony. Having suffered severe anoxic brain damage as a result of (...)
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  14. added 2018-10-27
    Still Human: A Thomistic Analysis of ‘Persistent Vegetative State’.Stewart Clem - 2019 - Studies in Christian Ethics 32 (1):46-55.
    Would Aquinas hold the view that a patient in a persistent vegetative state (PVS) is something other than a human being? Some recent interpreters have argued for this position. I contend that this reading is grounded in a false symmetry between the three stages of Aquinas’s embryology and the (alleged) three-stage process of death. Instead, I show that there are textual grounds for rejecting the view that the absence of higher brain activity in a patient would lead Aquinas to say (...)
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  15. added 2018-09-18
    Placing Pure Experience of Eastern Tradition Into the Neurophysiology of Western Tradition.Andrew And Alexander Fingelkurts - 2019 - Cognitive Neurodynamics 13 (1):121-123.
    While the presence or absence of consciousness plays the central role in the moral/ethical decisions when dealing with patients with disorders of consciousness (DOC), recently it is criticized as not adequate due to number of reasons, among which are the lack of the uniform definition of consciousness and consequently uncertainty of diagnostic criteria for it, as well as irrelevance of some forms of consciousness for determining a patient’s interests and wishes. In her article, Dr. Specker Sullivan reexamined the meaning of (...)
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  16. added 2018-06-10
    The Future of Inductive Risk for Disorders of Consciousness.Parker Crutchfield - 2016 - American Journal of Bioethics Neuroscience 7 (1):56-57.
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  17. added 2018-03-11
    Actual Physical Potentiality for Consciousness.Andrew And Alexander Fingelkurts - 2018 - American Journal of Bioethics Neuroscience 9 (1):24-25.
    Dr. Vukov analyzing patients with disorders of consciousness, proposed that medical well-regarded policy recommendations cannot be justified by looking solely to patients’ actual levels of consciousness (minimally conscious state – MCS versus vegetative state – VS), but that they can be justified by looking to patients’ potential for consciousness. One objective way to estimate this potential (actual physical possibility) is to consider a neurophysiologically informed strategy. Ideally such strategy would utilize objective brain activity markers of consciousness/unconsciousness. The Operational Architectonics (OA) (...)
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  18. added 2018-03-03
    意識測量儀初登場.Timothy Joseph Lane - 2018 - Scientific American 193:38-42.
    意識是如此不可捉摸又抽象的概念,「測量」意識簡直就像科幻小說情節。科學家近年來在這方面已大有進展,藉由各項腦造影技術和實驗手法,能夠分析不同意識狀態下的大腦活動型態。.
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  19. added 2017-12-03
    When Does Consciousness Matter? Lessons From the Minimally Conscious State.Joseph Vukov - 2018 - American Journal of Bioethics Neuroscience 9 (1):5-15.
    Patients in a minimally conscious state (MCS) fall into a different diagnostic category than patients in the more familiar vegetative states (VS). Not only are MCS patients conscious in some sense, they have a higher chance for recovery than VS patients. Because of these differences, we ostensibly have reason to provide MCS patients with care that goes beyond what we provide to patients with some VS patients. But how to justify this differential treatment? I argue we can’t justify it solely (...)
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  20. added 2017-11-27
    Unconscious Volition.Nada Gligorov - 2017 - American Journal of Bioethics Neuroscience 8 (3):151-152.
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  21. added 2017-10-26
    The Morality of Experience Machines for Palliative and End of Life Care.Dan Weijers - 2017 - In Mark Silcox (ed.), Experience Machines: The Philosophy of Virtual Worlds. Rowman & Littlefield. pp. 183-201.
    Experience machines, popularized in print by Robert Nozick and on the screen by the Wachowskis’ film The Matrix, provide highly or perfectly realistic experiences that are more pleasant and less painful than those generated in real life.1 The recent surge in virtual reality and neuro-prosthetic technologies is making the creation of real-world experience machines seem inevitable and perhaps imminent.2 Given the likelihood of the near-future availability of such machines, it behooves ethicists to consider the moral status of their potential uses. (...)
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  22. added 2017-09-21
    Consciousness, Intention, and Command-Following in the Vegetative State.Colin Klein - 2017 - British Journal for the Philosophy of Science 68 (1):27-54.
    Some vegetative state patients show fMRI responses similar to those of healthy controls when instructed to perform mental imagery tasks. Many authors have argued that this provides evidence that such patients are in fact conscious, as response to commands requires intentional agency. I argue for an alternative reading, on which responsive patients have a deficit similar to that seen in severe forms of akinetic mutism. Akinetic mutism is marked by the inability to form and maintain intentions to act. Responsive patients (...)
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  23. added 2017-08-07
    Should We Treat Vegetative and Minimally Conscious Patients as Persons?Matthew Braddock - 2017 - Neuroethics 10 (2):267-280.
    How should we treat patients diagnosed as being in a persistent vegetative state (PVS) or minimally conscious state (MCS)? More specifically, should we treat them as having the full moral status of persons? Yes, or so we argue. First, we introduce the medical conditions of PVS, MCS, and the related conditions of Locked-in Syndrome and covert awareness. Second, we characterize the main argument for thinking diagnosed PVS patients are not persons. Third, we contend that this argument is defeated by mounting (...)
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  24. added 2017-08-07
    The Uncertainty of Consciousness and Why It Is Important.Matthew Braddock - 2017 - American Journal of Bioethics Neuroscience 8 (3):155-157.
    How should we treat patients diagnosed with disorders of consciousness, such as patients diagnosed as minimally conscious or vegetative (yet who very well may be conscious)? Fischer and Truog (2017) argue that the consciousness and equal rights of these patients are relatively unimportant when deciding how we should treat them. That is, we should deemphasize their consciousness and equal rights and instead privilege the value judgments of the family/surrogate. We disagree. Drawing upon precautionary reasoning that we develop in Braddock (2017), (...)
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  25. added 2017-03-03
    Longitudinal Dynamics of 3-Dimensional Components of Selfhood After Severe Traumatic Brain Injury: A qEEG Case Study.Andrew A. Fingelkurts & Alexander A. Fingelkurts - 2017 - Clinical EEG and Neuroscience (5):327-337.
    In this report, we describe the case of a patient who sustained extremely severe traumatic brain damage with diffuse axonal injury in a traffic accident and whose recovery was monitored during 6 years. Specifically, we were interested in the recovery dynamics of 3-dimensional components of selfhood (a 3-dimensional construct model for the complex experiential selfhood has been recently proposed based on the empirical findings on the functional-topographical specialization of 3 operational modules of brain functional network responsible for the self-consciousness processing) (...)
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  26. added 2017-02-16
    Medically Assisted Nutrition and Hydration in End-Stage Dementia: Burdens and Benefits of Surgically-Placed Gastrostomy Tubes.Johanna Valiquette - 2008 - Medicina y Ética 19:259-271.
    Los tubos de gastrostomía aplicados quirúrgicamente son esenciales en el manejo de algunas condiciones. Sin embargo, muchos estudios indican una efectividad médica limitada y riesgos significativos en pacientes con demencia en estado avanzado. Los estudios no han demostrado los beneficios esperados, una mayor longevidad, un descenso en la neumonía por aspiración o mejora en la integridad de la piel. Los riesgos incluyen un deterioro cognitivo y funcional relacionado con la hospitalización, estrés por el uso de maniobras para sujetar al paciente, (...)
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  27. added 2017-02-15
    Severe Organic Brain Syndrome.Eduardo Bruera - forthcoming - Journal of Palliative Care.
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  28. added 2017-02-15
    Co-Variations Among Cognition, Cerebellar Disorders and Cortical Areas With Regional Glucose-Metabolic Activities in a Homogeneous Sample with Uner Tan Syndrome: Holistic Functioning of the Human Brain.Prof Dr Uner Tan - unknown
    Patients with Uner Tan syndrome exhibit habitual quadrupedal locomotion , intellectual disability, dysarthric speech and truncal ataxia. Examination of cognitive ability in this syndrome has not yet been demonstrated in the scientific literature. Aims: To analyze the cognitive abilities of the siblings with UTS; to assess the grade of their ataxia in relation to cerebellar disorders; to measure the metabolic activities of various cerebral regions in comparison with healthy individuals; to detect the interrelationships among all of the measured variables to (...)
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  29. added 2017-02-15
    On Omissions and Artificial Hydration and Nutrition.Bryan C. Pilkington - 2014 - Journal of Medicine and Philosophy 39 (4):430-443.
    Understanding what sorts of things one might be responsible for is an important component of understanding what one should do in situations where the administration of artificial hydration and nutrition are required to sustain the life of a patient. Relying on work done in the philosophy of action and on moral responsibility, I consider the implications of omitting the administration of artificial hydration and nutrition and instances in which the omitting agent would and would not be responsible for the death (...)
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  30. added 2017-02-15
    Ethical Issues in Secure Care.Gwen Adshead - 2009 - In Annie Bartlett & Gillian McGauley (eds.), Forensic Mental Health: Concepts, Systems, and Practice. Oxford University Press.
  31. added 2017-02-15
    Minimally Invasive Dentistry: A Treatment Philosophy.Stefano Ardu - unknown
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  32. added 2017-02-15
    The Ordinary-Extraordinary Distinction Reconsidered: A Moral Context for the Proper Calculus of Benefits and Burdens.Thomas J. Bole Iii - 1990 - HEC Forum 2 (4):219-232.
  33. added 2017-02-14
    Initial Reactions to the Pope's March 20, 2004, Allocution.Rev Germain Kopaczynski - 2004 - The National Catholic Bioethics Quarterly 4 (3):473-482.
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  34. added 2017-02-14
    Withdrawing or Withholding Artificial Hydration and Nutrition.M. A. Eby - 2000 - Nursing Ethics 7 (5):376-378.
  35. added 2017-02-14
    Human Nutrition and its Discontents: A Personal View.Howard A. Schneider - 1996 - Perspectives in Biology and Medicine 40 (1):1-6.
  36. added 2017-02-13
    Sensory Stimulation for Patients with Disorders of Consciousness: From Stimulation to Rehabilitation.Carlo Abbate, Pietro D. Trimarchi, Isabella Basile, Anna Mazzucchi & Guya Devalle - 2014 - Frontiers in Human Neuroscience 8.
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  37. added 2017-02-13
    Medically Assisted Nutrition and Hydration in Medicine and Moral Theology: A Contextualization of its Past and a Direction for its Future.John Berkman - 2004 - The Thomist 68 (1):69-104.
    Despite the expansive literature detailing various arguments for or against the use of MANH in caring for the dying and debilitated, the thesis of this paper is that a large part, if not the main thrust, of the debates over MANH have been inadequate and misguided on a number of different levels. The paper hopes to reorient and redirect the debate by attending to the medical history of MANH (part one) and recent medical developments with regard to MANH (part five), (...)
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  38. added 2017-02-13
    Psychosomatic Problems of Vegetative Regulatory Functions.H. Schaefer - 1966 - In John C. Eccles (ed.), Brain and Conscious Experience. Springer. pp. 522--547.
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  39. added 2017-02-12
    Possibilities and Limits of Mind-Reading: A Neurophilosophical Perspective.Kathinka Evers & Mariano Sigman - 2013 - Consciousness and Cognition 22 (3):887-897.
    Access to other minds once presupposed other individuals’ expressions and narrations. Today, several methods have been developed which can measure brain states relevant for assessments of mental states without 1st person overt external behavior or speech. Functional magnetic resonance imaging and trace conditioning are used clinically to identify patterns of activity in the brain that suggest the presence of consciousness in people suffering from severe consciousness disorders and methods to communicate cerebrally with patients who are motorically unable to communicate. The (...)
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  40. added 2017-02-12
    A Defense of Assisted Nutrition and Hydration in Patients with Dementia.John S. Howland - 2009 - The National Catholic Bioethics Quarterly 9 (4):697-710.
    Nutrition and hydration are common problems in advanced dementia. There has been growing opposition to the use of tube feeding in these patients both in and out of the Catholic Church. This article takes a critical look at current medical research on the subject and presents a vigorous defense of the use of artificial nutrition and hydration in dementia. A revealing case study is presented and a clear medical and ethical rationale are offered to support the appropriate use of ANH (...)
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  41. added 2017-02-12
    The Pope on the Moral Obligation to Continue Tube Feeding for Patients in Post-Coma Unresponsiveness.Norman Ford - 2004 - Chisholm Health Ethics Bulletin 9 (4):1.
  42. added 2017-02-12
    Commentary on" The Time Frame of Preferences, Dispositions, and the Validity of Advance Directives for the Mentally Ill".Rebecca Dresser - 1998 - Philosophy, Psychiatry, and Psychology 5 (3):247-249.
  43. added 2017-02-12
    Commentary on" The Time Frame of Preferences, Dispositions, and the Validity of Advance Directives for the Mentally Ill".Sally Burgess - 1998 - Philosophy, Psychiatry, and Psychology 5 (3):255-258.
  44. added 2017-02-12
    Commentary on" The Time Frame of Preferences, Dispositions, and the Validity of Advance Directives for the Mentally Ill".Dan W. Brock - 1998 - Philosophy, Psychiatry, and Psychology 5 (3):251-253.
  45. added 2017-02-12
    Commentary on" The Time Frame of Preferences, Dispositions, and the Validity of Advance Directives for the Mentally Ill".Nigel Lg Eastman - 1998 - Philosophy, Psychiatry, and Psychology 5 (3):259-261.
  46. added 2017-02-12
    The Time Frame of Preferences, Dispositions, and the Validity of Advance Directives for the Mentally Ill.Julian Savulescu & Donna Dickenson - 1998 - Philosophy, Psychiatry, and Psychology 5 (3):225-246.
  47. added 2017-02-11
    Empowering Patients is Good Medical Care.Jodi Halpern - 2013 - Philosophy, Psychiatry, and Psychology 20 (2):179-181.
    Walter and Ross rightfully argue that healthcare providers need to employ a less authoritarian, more empowering approach if they want to support patients’ behavioral changes. They show how motivational interviewing (MI), informed by self-determination theory, engages patients and thus may inspire enduring changes. They ground these interventions in an important, new model of relational autonomy, emphasizing the patient’s self-respect and self-cohesion as well as self-determination, and they show how patient–provider interactions influence these three aspects of autonomy. It may be surprising (...)
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  48. added 2017-02-11
    'Because We See Them Naked'–Nurses 'Experiences in Caring for Hospitalized Patients with Dementia: Considering Artificial Nutrition or Hydration (Anh)'.Els Bryon, Bernadette Dierckx De Casterlé & Chris Gastmans - 2012 - Bioethics 26 (6):285-295.
  49. added 2017-02-11
    Specific and Nonspecific Thalamocortical Functional Connectivity in Normal and Vegetative States.Shi-Jiang Li Jingsheng Zhou, Xiaolin Liu, Weiqun Song, Yanhui Yang, Zhilian Zhao, Feng Ling, Anthony G. Hudetz - 2011 - Consciousness and Cognition 20 (2):257.
    Recent theoretical advances describing consciousness from information and integration have highlighted the unique role of the thalamocortical system in leading to integrated information and thus, consciousness. Here, we examined the differential distributions of specific and nonspecific thalamocortical functional connections using resting-state fMRI in a group of healthy subjects and vegetative-state patients. We found that both thalamic systems were widely distributed, but they exhibited different patterns. Nonspecific connections were preferentially associated with brain regions involved in higher-order cognitive processing, self-awareness and introspective (...)
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  50. added 2017-02-11
    Assisted Nutrition and Hydration in Advanced Dementia of the Alzheimer’s Type.Peter J. Gummere - 2008 - The National Catholic Bioethics Quarterly 8 (2):291-306.
    Nutrition and hydration—including artificially delivered, or assisted, nutrition and hydration —are typically considered ordinary or proportionate care in the Roman Catholic moral tradition. They are thus morally obligatory, except when the benefit to the patient does not justify the burden their administration places on the patient or when they no longer prolong life. A review of Church documents and the medical literature provides convincing evidence that there are cases in which ANH provides little hope of benefit and may impose an (...)
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