Amnesia, Anesthesia, and Warranted Fear

Bioethics

Volumn 28, Issue 5, 2014, Pages 245-254

  Carbonell, Vanessa ^a  

^a UNIVERSITY OF CINCINNATI   (United States)

Author keywords

Amnesia; Anesthesia; Derek parfit; Fear; Midazolam; Personal identity; Sedation

Indexed keywords

HYPNOTIC SEDATIVE AGENT;

AMNESIA; ANESTHESIA; ANTICIPATION; ANXIETY; ATTITUDE; CHEMICALLY INDUCED; CONSCIOUS SEDATION; CONSCIOUSNESS; ETHICS; ETIOLOGY; FEAR; HUMAN; MEMORY; PAIN; PREVENTION AND CONTROL; PSYCHOLOGY; THINKING;

AMNESIA; ANESTHESIA; ANTICIPATION, PSYCHOLOGICAL; ANXIETY; ATTITUDE; CONSCIOUS SEDATION; CONSCIOUSNESS; FEAR; HUMANS; HYPNOTICS AND SEDATIVES; MEMORY; PAIN; THINKING;

EID: 84899840099     PISSN: 02699702     EISSN: 14678519     Source Type: Journal    
DOI: 10.1111/j.1467-8519.2012.01995.x     Document Type: Article

References (20)

1. David Shoemaker has recently argued that personal identity is irrelevant to bioethics (D. Shoemaker. The Insignificance of Personal Identity for Bioethics, Bioethics 2010 24: 481-489). He challenges others to come up with a bioethical issue in which the identity relation is doing any work. In this paper I consider whether a relaxed attitude toward forgotten pain may be caused by (among other things) a mistaken denial of identity between the person in pain and the person who earlier anticipates it or the person who later cannot remember it (all of whom are, I argue, obviously numerically identical). Ultimately, though, I think this mistake is too far-fetched to be very common. And in any case, what is really at issue here is not whether I am identical to the one in pain, but whether I should have egoistic concern for that person. Still, drug-induced amnesia may be an interesting place to look for those interested in whether personal identity is, in fact, irrelevant to bioethics.
2. For an early discussion of drug-induced amnesia and analgesia, and the importance of not taking the former to be a substitute for the latter, see D. Dennett. Why You Can't Make a Computer that Feels Pain. Synthese 1978 38: 415-456. See especially pages 431-437.
3. An interesting question is whether believing that one will have amnesia could affect the way one experiences the pain itself as it happens. Might the pain itself be perceived as less painful in light of expected amnesia? I know of no study examining this question. One study found that patients who had unknowingly received amnestic drugs before being asked to perform word-pair tasks showed no awareness of their impairment the drugs inhibited their performance, but they judged their own performance no differently from a placebo group, though they soon forgot nearly all of the words they had learned. See P. Merritt, E. Hirshman et al. Metamemory without the Memory: are People Aware of Midazolam-induced Amnesia? Psychopharmacology 2005 177: 336-343.
4. Fear may be fitting for other reasons as well. The patient may fear that the procedure will be unpleasant in ways unrelated to pain, or that something will go wrong during the procedure, or that - especially in diagnostic procedures - the doctor will discover a serious medical problem. The latter two fears would presumably not be alleviated by the belief that the patient will not remember the procedure. (And I will argue that the first fear, like the fear of pain, should not be affected by such knowledge.)
5. M. Orlewicz. Procedural Sedation. Medscape Reference. Updated November 8, 2011. Available at: http://emedicine.medscape.com/article/109695-overview#showall. [Accessed 18 April 2012].
6. R. Veselis. 2007. Memory: a Guide for Anaesthetists. Best Pract. Res., Clin. Anaesthesiol 2007 21: 297-312.
7. Orlewicz, op cit. note 5.
8. Veselis, op. cit. note 6, p. 297.
9. Sedation Dentistry. Austin Dental. Available at: http://www.austinsedationdentists.com/sedation-dentistry/ [Accessed 4 May 2012].
10. The psychic pain and anxiety associated with remembering a painful event is not to be dismissed. Preventing such memories may be a good reason to use amnestic drugs. For an interesting study of this phenomenon, see K. Kamata, S. Hagihira et al. Predominant Effects of Midazolam for Conscious Sedation: Benefits beyond the Early Postoperative Period. J. Anesth 2010 24: 869-876. In this study researchers found that giving patients midazolam before inserting an epidural catheter did not reduce their pain or anxiety immediately after the insertion, but did reduce their levels of anxiety and discomfort 20 hours after their surgery (for which they were given general anesthesia) compared with both a placebo and a non-amnestic sedative. One proposed explanation is that not remembering the pain of the epidural insertion contributes to the patients' post-operative sense of wellbeing and helps them recover better from the surgery.
11. D. Parfit. 1984. Reasons and Persons. Oxford: Oxford University Press: 206.
12. Parfit also discusses anticipation as a possible explanation for the bias toward the future. Anticipation is forward-looking it has no backward-looking counterpart, no faculty that provides 'pains of retrospection' (Parfit, op. cit. note 12, p. 174). Parfit claims that we can conceive of a creature that has such a backward-looking faculty and thus lacks the bias toward the future. Perhaps, I shall suggest, memory is the backward-looking analogue of anticipation. Nevertheless, there are differences between memory and anticipation, differences that may justify a bias toward the future.
13. I don't mean to suggest any relation to Allan Gibbard's metanormative theory, in which plans play a central role. See A. Gibbard. 2003. Thinking How to Live. Cambridge: Harvard University Press.
14. There are some deep issues about time in the background here. Some have argued that time is 'tenseless', and such a view might complicate my argument. Unfortunately there is not space here to do justice to these issues. See A.N. Prior. Thank Goodness That's Over. Philosophy 1959 34: 12-17
15. B. Garrett. 'Thank Goodness That's Over' Revisited. Philosophical Q 1988 38: 201-205
16. D. Kiernan-Lewis. Not Over Yet: Prior's 'Thank Goodness' Argument. Philosophy 1991 66: 241-243.
17. Veselis, op. cit. note 6, p. 306.
18. Parfit, op. cit. note 12, p. 245.
19. It might be helpful to put this point in the language of McMahan's theory of Time-Relative Interests (J. McMahan, op. cit. note 11).
20. Justin D'Arms and Daniel Jacobson have done illuminating work on the relationship between fittingness reasons and pragmatic reasons. They call the failure to distinguish the two types of reasons the 'Conflation Problem.' See J. D'Arms and D. Jacobson. 2000. Sentiment and Value. Ethics 110, 722-748. And they call it a 'Moralistic Fallacy' when we mistakenly infer an emotion's fittingness (or lack thereof) from the fact that it would (not) be good (morally or prudentially) to feel it. See J. D'Arms and D. Jacobson. 2000. The Moralistic Fallacy: On the 'Appropriateness' of Emotions. Philosophy and Phenomenological Research 61, 65-90.