Neil Levy

An interesting case is reported in the most recent issue of the Hastings Center Report.  Mrs Z, is a 29 year-old woman who was released into her husband’s carefollowing a traumatic brain injury. She is in a minimally conscious state (MCI), a state of severely impaired consciousness. MCI cases cover a range of cognitive deficits; Mrs Z seems to be at the lower end of cognitive functioning. She is unable to speak and requires 24 hour care, provided by her husband (who is also the guardian of their 4 year-old twins).

Read More »Sex and the minimally conscious state

Outside applied ethics and neuroethics, I work in philosophy of agency, specifically on the interlinked topics of free will and moral responsibility (interlinked because I, like most participants in the debate, understand free will, if it exists, to be the power we have to act in a way that makes us morally responsible for our actions). I defend a very unusual position in the free will debate, which I won’t get into now. But one feature it shares with some others (a relatively small minority) is that it holds that we don’t have free will, in the sense defined, and therefore we are not morally responsible for our actions (or for anything else). In this post, I want to address a common criticism of my argument, and of other arguments for the same conclusion. The criticism, roughly, is this: you are arguing for a radical revision of our beliefs and our practices: the overturning of a central component of our conception of ourselves and one another. But arguments for radical revisions of common sense must meet higher standards than arguments for less radical conclusions. As the stakes go up, so do the argumentative standards.

Read More »Arguing about moral responsibility

Back in November, I blogged about the case of Rom Houben, a man who after more than two decades in what was apparently a persistent vegetative state was found to be conscious. Following the newspaper reports of the time – as I noted at the time, I had nothing to go on except newspaper reports – I described it as a case in which the locked-in state was misdiagnosed as vegetative state. These mistakes do, tragically, occur. But we now know that Rom Houben is not in the locked-in state at all. The diagnosis of locked-in state was made on the basis of the use of facilitated communication, a technique in which someone is supposedly helped to communicate. Usually the facilitator guides the hand of the person they aim to help; the idea being that they can compensate for the muscular weakness by sensitively interpreting the person’s movements. Facilitated communication became notorious in the 1990s, when it was found that in most cases in which it was used (mainly to communicate with severely autistic individuals) the facilitators were producing the message. The test is simple: put headphones in both the facilitator and the person they are trying to help, and ask them questions simultaneously. Sometimes both receive the same questions, sometimes they receive different questions. The finding is that answers are always to the questions asked of the facilitator (obviously the fact that the facilitators have gladly participated in this research is good evidence of their sincerity. How we can mistake our own movements for someone else’s is a fascinating question, explored interestingly by Daniel Wegner in The Illusion of Conscious Will).

Read More »Coma Confusion Resolved

How exciting is the new research on the consciousness of patients diagnosed as in a persistent vegetative state (discussed here)? From a scientific point of view, this is an important piece of research. The ability to respond to yes/no questions is surely a reliable indicator of consciousness; once we have identified patients who can pass this test, we can begin to conduct other tests, to see whether the results correlate. We can begin to see whether the evidence of electrical activity in the brain in response to words or to physical discomfort reflect consciousness or are merely indicators of unconscious activity.  The new research also might have great diagnostic value. But we must be careful not to overinterpret the results.

Read More »Brain imaging and PVS: How excited should we be?

By now most readers will have heard about the case of the Belgian man, Rom Houben, apparently misdiagnosed as in a persistent vegetative state for 23 years. Rather than being unconscious, as persistent vegetative state patients are thought to be, he was apparently in the ‘locked-in state’. The locked-in state is not a disorder of consciousness at all; instead it is a state of paralysis. Because the patient is unable to give the behavioral manifestations of consciousness, they are often misdiagnosed. Genuine disorders of consciousness are notoriously hard to tell apart; the possibility of locked-in syndrome makes the diagnostic task even more difficult.

Read More »Belgian coma confusion