Personhood and Persistent Vegetative State

What Is PVS?

Permanent unconsciousness NOT coma-- sleep wake cycles Random movements No purposeful movements Cannot perceive any environmental

stimuli (including pain) Spontaneous breathing after initial phase

What is PVS? Cont.

Brain stem intact Cerebral hemispheres irreversibly

damaged No single sign is conclusively diagnostic Can be diagnosed with confidence 1-12

months after initial injury depending on age, nature of injury

Persistent Vegetative State = Higher Brain Death

Cerebrum

Brain stem Cerebellum

PVS vs. Whole brain death

Legally alive Loss of cerebral

function only Permanently

unconscious Can maintain for up

to 37 years Rare cases of some

recovery

Legally dead Loss of cerebral +

brain stem Permanently

unconscious Can maintain for up

to 3 months No cases of any

recovery

PVS vs. Whole brain death

Not truly a type of “coma”

Spontaneous respiration

Sleep-wake cycles Various reflexes but

no purposeful movement

No clear list of tests

Deepest possible coma

No spontaneous respiration

No sleep-wake cycles

Spinal reflexes only Unambiguous

diagnosis

Importance of Personhood

Basic moral ideal: respect for persons In almost all cases, a living human

being is a person Borderline cases

– Human fetus– PVS– Anencephalic infant

Mental capacity view of personhood Favored by Arras and many others Person = potential bearer of rights and

interests To have interests it must make a

difference to you for your own sake what is done to you

To make a difference must have minimal level of awareness

Mental capacity

If one irreversibly lacks that minimal level of awareness of self and surroundings, not a “person” in the strict moral sense

Applies clearly to PVS: Former person, no longer one

Applies clearly to anencephalic infant: never can become a person

Risks?

“Nonperson” status in past often used as mode of discrimination against minorities (Nazis, etc.)

Reply: Mental capacity is different because it clearly made a difference to victims of Nazis what happened to them

Test: what would I want done to and for myself, if I were later to enter a PVS?

Criterion for death?

Proposal: We care about the deaths of persons, not about the deaths of human bodies

Therefore should have higher brain not whole brain criterion for death

Practical problem: ease and certainty of diagnosis

A differing (religious) view

All living human beings are worthy of respect and dignity

Ongoing life is always a “benefit” A feeding tube thus provides a benefit

with very little if any burden PVS is an extreme disability so

nontreatment mean treating the disabled as less than full persons