To fulfill their crucial duty of relieving suffering in their patients, physicians may have to administer palliative sedation when they implement treatment-limitation decisions such as the withdrawal of life-supporting interventions in patients with poor prognosis chronic severe brain injury. The issue of palliative sedation deserves particular attention in adults with serious brain injuries and in neonates with severe and irreversible brain lesions, who are unable to express pain or to state their wishes. In France, treatment limitation decisions for these patients (...) are left to the physicians. Treatment-limitation decisions are made collegially, based on the presence of irreversible brain lesions responsible for chronic severe disorders of consciousness. Before these decisions are implemented, they are communicated to the relatives. Because the presence and severity of pain cannot be assessed in these patients, palliative analgesia and/or sedation should be administered. However, palliative sedation is a complex strategy that requires safeguards to prevent a drift toward hastening death or performing covert euthanasia. In addition to the law on patients' rights at the end of life passed in France on April 22, 2005, a recent revision of Article 37 of the French code of medical ethics both acknowledges that treatment-limitation decisions and palliative sedation may be required in patients with severe brain injuries and provides legal and ethical safeguards against a shift towards euthanasia. This legislation may hold value as a model for other countries where euthanasia is illegal and for countries such as Belgium and Netherlands where euthanasia is legal but not allowed in patients incapable of asking for euthanasia but in whom a treatment limitation decision has been made. (shrink)

Pain is an unwanted mental state that is often considered a sufficient ground for moral status. However, current science and philosophy of mind suggest that pains, like other perceptual states, might be nonconscious. This raises the questions of whether the notion of nonconscious pain is coherent and what its moral significance might be. In this paper I argue that the existence of nonconscious pain is conceptually coherent; however as a matter of fact our brains might always represent pains consciously. I (...) then characterize the concept of suffering from a naturalistic perspective, distinguishing it from pain. I offer an account of suffering based on some current theories of consciousness, in which suffering consists in the global broadcasting of representations with overall net negative valence. I argue this can explain most of suffering’s properties, such as its wholeness, significance for welfare, and conscious character. Finally, I contend that suffering, but not pain, provides sufficient grounds for moral status. (shrink)

The phenomenal view of thought holds that thinking is an experience with phenomenal character that determines what the thought is about. This paper develops and responds to the objection that the phenomenal view is chauvinistic: it withholds thoughts from creatures that in fact have them. I develop four chauvinism objections to the phenomenal view—one from introspection, one from interpersonal differences, one from thought experiments, and one from the unconscious thought paradigm in psychology—and show that the phenomenal view can resist all (...) four. (shrink)