Graham Mackenzie
Uehiro Centre for Practical Ethics, Wellcome Centre for Ethics and Humanities, Oxford University, Oxford, UK.
Neuroethics. 2019;12(2):153-169. doi: 10.1007/s12152-018-9361-z. Epub 2018 May 21.
Unresponsive wakefulness syndrome is a disorder of consciousness wherein a patient is awake, but completely non-responsive at the bedside. However, research has shown that a minority of these patients remain aware, and can demonstrate their awareness via functional neuroimaging; these patients are referred to as having 'cognitive motor dissociation' (CMD). Unfortunately, we have little insight into the subjective experiences of these patients, making it difficult to determine how best to promote their well-being. In this paper, I argue that the capacity to experience pain or pleasure (sentience) is a key component of well-being for these patients. While patients with unresponsive wakefulness syndrome are believed to be incapable of experiencing pain or pleasure, I argue that there is evidence to support the notion that CMD patients likely experience pain and pleasure. I analyze current neuroscientific research into the mechanisms of pain experience in patients with disorders of consciousness, and provide an explanation for why CMD patients likely can experience physical pain. I then do the same for physical pleasure. I conclude that providing these patients with pleasurable experiences, and avoiding subjecting them to pain, are viable means of promoting their well-being.
无反应觉醒综合征是一种意识障碍，患者处于清醒状态，但在床边完全无反应。然而，研究表明，这些患者中有少数人仍有意识，并可通过功能神经影像学证明其意识；这些患者被称为具有“认知运动分离”（CMD）。不幸的是，我们对这些患者的主观体验了解甚少，因此很难确定如何最好地促进他们的福祉。在本文中，我认为体验疼痛或愉悦（感知能力）的能力是这些患者福祉的关键组成部分。虽然无反应觉醒综合征患者被认为无法体验疼痛或愉悦，但我认为有证据支持CMD患者可能体验疼痛和愉悦这一观点。我分析了当前关于意识障碍患者疼痛体验机制的神经科学研究，并解释了CMD患者可能体验身体疼痛的原因。然后我对身体愉悦也进行了同样的分析。我的结论是，为这些患者提供愉悦的体验，并避免使他们遭受疼痛，是促进他们福祉的可行方法。
