Alleva, Enrico

Bonsignore, Luca Tommaso

Chiarotti, Flavia

Macrì, Simone

Petrini, Carlo

Annali dell'Istituto Superiore di Sanità

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Enrico Alleva(a), Luca Tommaso Bonsignore(a), Flavia Chiarotti(a), Simone Macrì(a) 
and Carlo Petrini(b) 
Preface
Monographic section: 
Clinical, bioethical and experimental 
considerations behind the study
of coma patients
(a) Dipartimento di Biologia Cellulare e Neuroscienze, Istituto Superiore di Sanità, Rome, Italy
(b) Unità di Bioetica, Presidenza, Istituto Superiore di Sanità, Rome, Italy
Ann Ist Super Sanità 2014 | Vol. 50, No. 3: 208
DOI: 10.4415/ANN_14_03_02
This special section stems from the activities of a 
project developed through a funding from the Italian 
Ministry for Health. Such a project (2010-2012), aimed 
at revising the current nosography of vegetative states 
through the application of innovative behavioural anal-
ysis methods. The core of the project was an attempt to 
integrate the current methodologies, developed in the 
field of psychobiology, with those adopted in clinical 
settings involved in the care and cure of patients with 
disorders of consciousness. 
At the beginning of this endeavour we were persuaded 
that our knowledge would complement the expertise of 
eminent colleagues approaching the same medical con-
dition from a rather different perspective. By the same 
token, we were persuaded that disorders of conscious-
ness constitute a very special form of medical condition: 
a form that, beside physical treatments, entails funda-
mental philosophical and ethical considerations. Whilst 
philosophical aspects dealing with the fine line between 
“life” and “death” fell beyond our reach, we deemed eth-
ical considerations worth of being addressed within the 
actual scopes of the Istituto Superiore di Sanità (ISS, 
Italian National Institute of Health). Ethical aspects 
in such project encompass numerous facets: from the 
legal requirements that shall be met while performing 
any experimental study involving subjects incapable of 
providing their consent to the relevance of a misdiag-
nosis in a disease of consciousness wherein the tools to 
address consciousness are, as yet, inadequate.
Far too often have we been discussing the integration 
among these fields of investigation, both inside and out-
side our research group. Which discipline among medi-
cine, psychobiology, ethics, and philosophy shall even-
tually prevail? Shall any of them prevail indeed? Can 
they be integrated to provide fundamental insights in 
the transition among different states of consciousness?
We proposed this special section of the Annali 
dell’Istituto Superiore di Sanità to tentatively address 
these fundamental questions: to this aim, we gathered 
key figures in the study of disorders of consciousness 
and asked them to share their knowledge. Natale Gas-
pare De Santo agreed to contribute a theoretical manu-
script detailing philosophical aspects of life and death 
and how they may contribute to the analysis of patients 
with disorders of consciousness. Carlo Petrini, Michele 
Farisco, and Kathinka Evers tackle the study of this 
group of patients from an ethical perspective: to this 
aim, ranging from human dignity to European regula-
tions, they discuss the fundamental principles govern-
ing the execution of experimental studies involving 
subjects incapable of providing informed consent. They 
also discuss the extent to which inappropriate diagnos-
tic tools, in this special field, may increase the odds of 
misdiagnosis and, in turn, generate primary ethical is-
sues. Drifting towards medical and technical aspects, 
Giuliano Dolce and colleagues first discuss the noso-
graphical behavioural categories adopted to categorize 
different states of consciousness, and then describe the 
most recent advancements in the neurorehabilitation of 
patients presenting with severe disorders of conscious-
ness. Carol Di Perri and collaborators complement the 
work of Dolce and colleagues cogently detailing the rel-
evance of technology-based measures in the diagnosis 
of disorders of consciousness. Finally, Bonsignore and 
colleagues describe a study aimed at combining tech-
nology-based tools with innovative behavioural observa-
tions in the description of different states of conscious-
ness. 
In conclusion, we would like to thank the editorial board 
of the Annali dell’Istituto Superiore di Sanità who welcomed 
our proposal for this special section, while offering gener-
ous and valuable technical support for its completion. 


Monographic section; Clinical, bioethical and experimental considerations behind the study of coma patients. Preface

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Monographic section; Clinical, bioethical and experimental considerations behind the study of coma patients. Preface

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