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Settling this uncertainty requires that one becomes clear about two issues: the type of functional loss that is associated with the respective profile of brain damage and the persistence conditions of persons. Medical case studies can answer the former question, but they are not concerned with the latter. Conversely, in the philosophical literature, various accounts of personal identity are discussed, but usually detached from any empirical basis. Only uniting the two debates and interpreting the real-life configurations of brain damage through the lens of the philosophical concepts enables one to make an informed judgment regarding the persistence of comatose persons. Especially challenging are cases in which three mental characteristics that normally occur together\u2014wakefulness, awareness and memory storage\u2014come apart. 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Oxford: Blackwell, 1984."},{"key":"2024111107200757000_46.2.99.7","doi-asserted-by":"publisher","DOI":"10.2307\/2025324"},{"key":"2024111107200757000_46.2.99.8","doi-asserted-by":"publisher","DOI":"10.2307\/2184309"},{"issue":"4","key":"2024111107200757000_46.2.99.9","first-page":"269","article-title":"Persons and their pasts","volume":"7","author":"Shoemaker","year":"1970","journal-title":"Am Philos Q"},{"key":"2024111107200757000_46.2.99.10","unstructured":"Nagel T . The View from Nowhere. New York: Oxford University Press, 1986."},{"key":"2024111107200757000_46.2.99.11","doi-asserted-by":"crossref","unstructured":"McMahan J . The Ethics of Killing: Problems at the Margins of Life. Oxford: Oxford University Press, 2002.","DOI":"10.1093\/0195079981.001.0001"},{"key":"2024111107200757000_46.2.99.12","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-8519.1995.tb00305.x"},{"key":"2024111107200757000_46.2.99.13","unstructured":"Gervais KG . Redefining Death. New Haven: Yale University Press, 1986."},{"key":"2024111107200757000_46.2.99.14","doi-asserted-by":"crossref","unstructured":"Unger P . Identity, Consciousness and Value. New York: Oxford University Press, 1990.","DOI":"10.1093\/oso\/9780195054019.001.0001"},{"key":"2024111107200757000_46.2.99.15","unstructured":"Academy of Medical Royal Colleges . A Code of Practice for the Diagnosis and Confirmation of Death. London: Academy of Medical Royal Colleges, 2008."},{"key":"2024111107200757000_46.2.99.16","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0905370"},{"issue":"5792","key":"2024111107200757000_46.2.99.17","doi-asserted-by":"crossref","DOI":"10.1126\/science.1130197","article-title":"Detecting awareness in the vegetative state","volume":"313","author":"Owen","year":"2006","journal-title":"Science"},{"issue":"1","key":"2024111107200757000_46.2.99.18","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1080\/20508549.1999.11878373","article-title":"Recovery from \"brain death\": a neurologist's apologia","volume":"64","author":"Shewmon","year":"1997","journal-title":"Linacre Q"},{"key":"2024111107200757000_46.2.99.19","unstructured":"Miller FG , Truog RD . Death, Dying, and Organ Transplantation: Reconstructing Medical Ethics at the End of Life. Oxford: Oxford University Press, 2016."},{"key":"2024111107200757000_46.2.99.20","unstructured":"Crossman AR , Neary D . Neuroanatomy: an Illustrated Colour Text. 5th ed. Edinburgh: Elsevier, 2015."},{"issue":"2","key":"2024111107200757000_46.2.99.21","first-page":"105","article-title":"Brain death and personal identity","volume":"9","author":"Green","year":"1980","journal-title":"Philos Public Aff"},{"issue":"7","key":"2024111107200757000_46.2.99.22","first-page":"783","article-title":"[Role of the cerebellum in the acquisition and consolidation of motor memory]","volume":"60","author":"Nagao","year":"2008","journal-title":"Brain Nerve"},{"key":"2024111107200757000_46.2.99.23","doi-asserted-by":"publisher","DOI":"10.1016\/0013-4694(49)90066-8"},{"key":"2024111107200757000_46.2.99.24","unstructured":"Pallis C , Harley DH . ABC of Brainstem Death. 2nd ed. London: BMJ, 1996."},{"key":"2024111107200757000_46.2.99.25","unstructured":"Plum F , Posner JB . The Diagnosis of Stupor and Coma. 3rd ed. Philadelphia: Davis, 1980."},{"issue":"4","key":"2024111107200757000_46.2.99.26","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.jcgg.2011.08.001","article-title":"\u201cThe locked-in syndrome\u201d: can it be unlocked?","volume":"2","author":"Khanna","year":"2011","journal-title":"J Clin Gerontol Geriatr"},{"key":"2024111107200757000_46.2.99.27","doi-asserted-by":"publisher","DOI":"10.1097\/NEN.0b013e3182588293"},{"key":"2024111107200757000_46.2.99.28","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/j.neulet.2015.09.004","article-title":"The direct pathway from the brainstem reticular formation to the cerebral cortex in the ascending reticular activating system: a diffusion tensor imaging study","volume":"606","author":"Jang","year":"2015","journal-title":"Neurosci Lett"},{"key":"2024111107200757000_46.2.99.29","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awg166"},{"issue":"7","key":"2024111107200757000_46.2.99.30","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1038\/scientificamericanmind0110-20","article-title":"Reviving consciousness","volume":"20","author":"Koch","year":"2010","journal-title":"Sci Am Mind"},{"key":"2024111107200757000_46.2.99.31","doi-asserted-by":"crossref","unstructured":"Moll CKE , Sharott A , Hamel W , et al . 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