Abstract
Detecting conscious awareness in a patient emerging from a coma state is problematic, because our standard attributions of conscious awareness rely on interpreting bodily movement as intentional action. Where there is an absence of intentional bodily action, as in the vegetative state, can we reliably assume that there is an absence of conscious awareness? Recent neuroimaging work suggests that we can attribute conscious awareness to some patients in a vegetative state by interpreting their brain activity as intentional mental action. I suggest that this change of focus, from the interpretation of motor behaviour as intentional bodily action to the interpretation of neural activity as intentional mental action, raises philosophical issues that affect the interpretation of the neuroimaging data.
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References
Bargh JA (1989) Conditional automaticity: varieties of automatic influences in social perception and cognition. In: Uleman JS, Bargh JA (eds) Unintended thought. Guilford Press, New York, pp 3–51
Bayne T (2013) Agency as a marker of consciousness In: Clark A, Kiverstein J, Vierkant T (eds) Decomposing the will. Oxford University Press, Oxford, pp 160–182
Block N (2007) Consciousness, accessibility, and the mesh between psychology and neuroscience. Behav Brain Sci 30:481–548
Chalmers DJ (1997) Availability: the cognitive basis of experience? In: Block N, Flanagan OJ, Guzeldere G (eds) The nature of consciousness. MIT Press, Cambridge
de Jong B, Willemsen AT, Paans AM (1997) Regional cerebral blood flow changes related to affective speech presentation in persistent vegetative state. Clin Neurol Neurosurg 99:213–216
Giacino JT, Ashwal S, Childs N, Cranford R, Jennett B, Katz DI, Kelly JP et al (2002) The minimally conscious state definition and diagnostic criteria. Neurology 58(3):349–353
Gross MAF, Nager W, Quandt C, Münte TF, Münte S (2004) Auditory processing in patients under general anaesthesia. An event related brain potential (ERP) study. British J Anaesth 93:486
Kotchoubey B, Daltrozzo J, Wioland N, Mutschler V, Lutun P, Birbaumer N, Jaeger A (2005) Semantic processing in a coma patient. Gd Rounds 5:37–41
Mele AR (1997) Agency and mental action. Philos Perspect 11:231–249
Menon DK, Owen AM, Williams EJ et al (1998) Cortical processing in persistent vegetative State. Lancet 352:200
Monti MM, Vanhaudenhuyse A, Coleman MR, Boly M, Pickard JD, Tshibanda L, Owen AM, Laureys S (2010) Willful modulation of brain activity in disorders of consciousness. N Engl J Med 362:579–589
Munte S, Kobbe I, Demertzis A et al (1999) Increased reading speed for stories presented during general anesthesia. Anesthesiology 90:662–669
Owen AM, Coleman MR, Menon DK et al (2005) Residual auditory function in persistent vegetative state: a combined PET and fMRI study. Neuropsychol Rehab 15:290–306
Owen AM, Coleman MR, Boly M, Davis MH, Laureys S, Pickard JD (2006) Detecting awareness in the vegetative state. Science 313:1402
Owen AM, Coleman MR, Boly M, Davis MH, Laureys S, Pickard JD (2007) Using functional magnetic resonance imaging to detect covert awareness in the vegetative state. Arch Neurol 64:1098–1102
Peacocke C (2007) Mental action and self-awareness (I). In: McLaughlin B, Cohen J (eds) Contemporary debates in philosophy of mind. Blackwell, Oxford
Plum F, Posner JB (1982) The diagnosis of stupor and coma, vol 19. Oxford University Press, USA
Quandt C, Nager W, Gross MAF, Löffler N, Piepenbrock SA, Münte TF, Münte S (2004) Auditory perception during general anaesthesia with sevoflurane-event related potentials (ERP) indicate orienting mechanisms. British J Anaesth 93(3):488
Rodd JM, Davis MH, Johnsrude IS (2005) The neural mechanisms of speech comprehension: fMRI studies of semantic ambiguity. Cereb Cortex 15:1261–1269
Royal College of Physicians (2003) The vegetative state: guidance and diagnosis on management. RCP, London
Shea N, Bayne T (2010) The vegetative state and the science of consciousness. British J Philos Sci 61:459–484
Soteriou M (2009) Mental agency, conscious thinking, and phenomenal character. In: O'Brien L, Soteriou M (eds) Mental Actions. Oxford University Press
Strawson G (2003) Mental ballistics or the involuntariness of spontaneity. Proc Aristot Soc 103:227–256
Acknowledgments
Work on this paper began on David Chalmers’ ARC-funded project on ‘The Contents of Consciousness’ at the Australian National University, and an early version of this paper was presented at the University of Western Australia in February 2012. In its current version, this paper was presented at the first Topoi conference in November 2012, where it benefitted immensely from the feedback of conference participants, in particular: Marcel Brass, Cristiano Castlefranchi, Elisabeth Pacherie, Fabio Paglieri, Markus Schlosser, Corrado Sinigaglia, Bruno Verbeek, and Tillman Vierkant. Thanks are also due to Topoi’s anonymous reviewers.
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Drayson, Z. Intentional Action and the Post-Coma Patient. Topoi 33, 23–31 (2014). https://doi.org/10.1007/s11245-013-9185-8
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DOI: https://doi.org/10.1007/s11245-013-9185-8