ORIGINAL PAPER The Ethical Pain Detection and Management of Pain and Suffering in Disorders of Consciousness Michele Farisco Received: 14 January 2011 /Accepted: 5 April 2011 /Published online: 16 April 2011 # Springer Science+Business Media B.V. 2011 Abstract The intriguing issue of pain and suffering in patients with disorders of consciousness (DOCs), particularly in Unresponsive Wakefulness Syndrome/ Vegetative State (UWS/VS) and Minimally Con- scious State (MCS), is assessed from a theoretical point of view, through an overview of recent neuroscientific literature, in order to sketch an ethical analysis. In conclusion, from a legal and ethical point of view, formal guidelines and a situationist ethics are proposed in order to best manage the critical scientific uncertainty about pain and suffering in DOCs and ensure the best possible care for the patient. Keywords Disorders of consciousness . Vegetative State . Minimally Conscious State . Pain . Suffering . Clinical ethics Introduction To date no many studies have been dedicated to the issue of pain perception and suffering in DOC patients (particularly in UWS/VS and MCS), and, despite a progress in our knowledge, a critical uncertainty remains [1]. Additionally, only acute pain has been well investigated: we do not know very well about possible chronic pain in these patients, particularly whether there is a sort of baseline pain or suffering and whether they interfere with the ability to perceive a particular noxious stimulus [2]. Further investigations on this topic may be useful. The issue of pain and suffering in DOC patients raises not only scientific, but also ethical questions. The aim of this paper is thinking about the possible perception of pain by DOC patients in order not to assign them a moral status (which would be relevant to decide what to do regarding the so called ‘end-of-life decisions’), but only to decide whether it is ethically right, due or optional to treat them with analgesics. Notwithstanding the relevance of both issues, the latter is surely an ethical and legal problem affecting the everyday practice of many more people than the first. Given this state of art, what level of uncertainty is acceptable at a legal and ethical levels [3]? We think that from a social and public point of view, in order to take decisions regarding DOC patients management the best strategy is the connection between neuroscience and other fields, especially law and ethics: we do not have to wait for neuroscience clarifies all its doubts, but we have to deal exactly with this uncertainty. If we were not uncertain we would not need laws and ethical principles to assess our actions. Neuroethics (2013) 6:265–276 DOI 10.1007/s12152-011-9111-y M. Farisco (*) Department of Philosophy, Pontifical Faculty of Theology of Southern Italy, ‘S. Tommaso d’Aquino’, Naples, Viale Colli Aminei, 2, 80131 Naples, Italy e-mail: michelefarisco@inwind.it