Michael Bruno

Williams (1970) argues that our intuitions about personal identity vary depending on how a given thought experiment is framed. Some frames lead us to think that persistence of self requires persistence of one's psychological characteristics; other frames lead us to think that the self persists even after the loss of one's distinctive psychological characteristics. The current paper takes an empirical approach to these issues. We find that framing does affect whether or not people judge that persistence of psychological characteristics is required for persistence of self. Open-ended, abstract questions about what is required for survival tend to elicit responses that appeal to the importance of psychological characteristics. This emphasis on psychological characteristics is largely preserved even when participants are exposed to a concrete case that yields conflicting intuitions over whether memory must be preserved in order for a person to persist. Insofar as our philosophical theory of personal identity should be based on our intuitions, the results provide some support for the view that psychological characteristics really are critical for persistence of self.

Pain, suffering and positive emotions in patients in vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious states (MCS) pose clinical and ethical challenges. Clinically, we evaluate behavioural responses after painful stimulation and also emotionally-contingent behaviours (e.g., smiling). Using stimuli with emotional valence, neuroimaging and electrophysiology technologies can detect subclinical remnants of preserved capacities for pain which might influence decisions about treatment limitation. To date, no data exist as to how healthcare providers think about end-of-life options (e.g., withdrawal of artificial nutrition and hydration) in the presence or absence of pain in non-communicative patients. Here, we aimed to better clarify this issue by re-analyzing previously published data on pain perception (Prog Brain Res 2009 177, 329–38) and end-of-life decisions (J Neurol 2010 258, 1058–65) in patients with disorders of consciousness. In a sample of 2259 European healthcare professionals we found that, for VS/UWS more respondents agreed with treatment withdrawal when they considered that VS/UWS patients did not feel pain (77%) as compared to those who thought VS/UWS did feel pain (59%). This interaction was influenced by religiosity and professional background. For MCS, end-of-life attitudes were not influenced by opinions on pain perception. Within a contemporary ethical context we discuss (1) the evolving scientific understandings of pain perception and their relationship to existing clinical and ethical guidelines; (2) the discrepancies of attitudes within (and between) healthcare providers and their consequences for treatment approaches, and (3) the implicit but complex relationship between pain perception and attitudes toward life-sustaining treatments