Theo Todman's Web Page - Paper Abstracts

Author’s Abstract

• How shall we regard those in persistent vegetative state¹? They are periodically awake, and their bodies breathe and digest on their own. These traits bespeak life. Yet they are not conscious and never will be: subjectively, this is death. Similarly, they may be, except neurologically and psychologically, quite healthy, capable of remaining in their condition for many years with only minimal care. Yet in considering treatment options we class them with the dying, perplexed over the permissibility of withholding care and letting patients die with dignity.
• Given these uncertainties, should patients in persistent vegetative state² be maintained? A growing societal consensus answers in the negative. I support this conclusion, but puzzle over the rationale for it. The kind of reasoning that has been used in deciding-to-die cases of the past two decades has, I believe, begun to fail us. New kinds of cases are being discussed in an old, increasingly obsolete vocabulary.
• Persistent vegetative state³, I further believe, is a case in point. Indeed, our consideration of persistent vegetative state⁴ permits two distinct views of its place in this evolution. In one aspect, it represents a relatively new kind of problem, the disposition of patients whose lives are stable but not worth living. But persistent vegetative state⁵ can also be seen as the last stage of another development: the changing definition of death. Likewise, persistent vegetative state⁶ can be conceived either as the lowest- functioning phase of life, or as the highest- functioning phase of death; the ethics of treatment can be discussed under either rubric. These two ways of construing the problem point to somewhat different laws and clinical practices, and the choice between them will affect our treatment not only of patients in persistent vegetative state⁷ but also of those in less debilitated conditions.