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The harm of intraoperative awareness
  1. Neil Levy
  1. Correspondence to Dr Neil Levy, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC 3010, Australia; nllevy{at}

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As Walter Glannon notes1, Ned Block famously distinguished two central concepts of consciousness.2 ‘Phenomenal’ consciousness is the kind of consciousness that has a qualitative feel to it. It is the kind of consciousness involved in feelings and sensations. Information is ‘access’ conscious when the agent is aware of it—paradigmatically, when he/she is able to report it. Phenomenal consciousness is the kind of consciousness that is central to debates in philosophy of mind, especially debates about the hard problem and the explanatory gap, both of which concern the apparent difficulty of explaining how qualia can arise from mere matter.

Glannon thinks that, in discussions of the ethical issues arising out of the possibility of becoming conscious during surgery, it is phenomenal consciousness that is ‘the relevant type of consciousness’.1 Since only phenomenal consciousness can hurt, pain is intrinsically a matter of phenomenal consciousness (there is a lively debate concerning whether mental states with informational content have a phenomenology associated with them,3 but this is best understood as a debate about whether at least some access conscious states are also phenomenally conscious states, not about whether access conscious states can, qua such states, have a phenomenology). Phenomenal consciousness of pain may be intrinsically bad; further, it may be that only if we (phenomenally) feel pain can we suffer from it by reacting emotionally to it (and these emotional reactions may be intrinsically phenomenal too). Phenomenal consciousness of pain may also be necessary for psychological problems to arise, such as post-traumatic stress disorder (PTSD).

In this commentary, I want to suggest that access consciousness may matter more …

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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.

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