The case presented illustrates ambiguities concerning the state of consciousness and the management of patients with catastrophic brain injuries. The ethical problem presented centers on the administration of a morphine infusion in the hope of achieving an appearance of lessened "distress" in a comatose patient who exhibits an increased respiratory rate drive as the result of primary neurologic and metabolic causes. The house officer identifies difficulties in providing a mechanistic account of the possible level of awareness in the patient and the possiblity of pain and suffering