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I am grateful to Neil Levy, Adam Kolber and Andrew Davidson for their thoughtful and thought-provoking responses to my article.1 They have raised interesting and important questions about different aspects of intraoperative awareness.
Contrary to what I have argued, Levy suggests that access consciousness may matter more to questions of intraoperative pain and harm than phenomenal consciousness.2 He presents the example of pain asymbolia as providing some evidence that the harm from pain is not a function of how it phenomenally feels. A similar anxiolytic effect may occur in patients receiving a drug such as midazolam under conscious sedation. But this does not mean that there is no phenomenal aspect to the experience of pain. Levy2 says that pain asymbolia is an example of access consciousness insofar as it involves information available to a sufficient number of consuming systems constituting the mind. Phenomenal and access consciousness are mental manifestations of underlying neural networks, and knowing whether or to what extent these networks are active is necessary for identifying which type of consciousness the patient possesses. There may be varying degrees of awareness depending on how much information is integrated in the brain when the patient becomes aware. Lesser and greater degrees of …
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.