Resolving the ethical quagmire of the persistent vegetative state

Abstract

BackgroundA patient is diagnosed with the persistent vegetative state (PVS) when they show no evidence of the awareness of the self or the environment for an extended period of time. The chance of recovery of any mental function or the ability to interact in a meaningful way is low. Though rare, the condition, considering its nature as a state outwith the realm of the conscious, coupled with the trauma experienced by the patient's kin as well as health care staff confronted with painful decisions regarding the patient's care, has attracted a considerable amount of discussion within the bioethics community.AimsAt present, there is a wealth of literature that discusses the relevant neurology, that elucidates the plethora of ethical challenges in understanding and dealing with the condition, and that analyses the real‐world cases which have prominently featured in the mainstream media as a result of emotionally charged, divergent views concerning the provision of care to the patient. However, there is scarcely anything in the published scholarly literature that proposes concrete and practically actionable solutions to the now widely recognized moral conundrums. The present article describes a step in that direction.Materials & MethodsI start from the very foundations, laying out a sentientist approach which serves as the basis for the consequent moral decision‐making, and then proceed to systematically identify and deconstruct the different cases of discord, using the aforementioned foundations as the basis for their resolution.ResultsA major intellectual contribution concerns the fluidity of the duty of care which I argue is demanded by the sentientist focus.DiscussionThe said duty is shown initially to have for its object the patient, which depending on the circumstances, can change to the patient's kin, or the health care staff themselves.ConclusionIn conclusion, the proposed framework represents the first comprehensive proposal regarding the decision‐making processes involved in the deliberation on the provision of life sustaining treatment to a patient in a PVS.

Crime and Punishment: A Rethink

“…Indeed, in the present article I too advocate for the abandonment of imprisonment for punitive means, reserving its use for incapacitation of dangerous offenders (or, equivalently, the protection of their likely victims), which would have prisons change both in their nature and appearance, though on a philosophical basis quite unlike that of Zeki et al [17]. My overall thesis is premised on a basis that can be described as sentientist [18], centering on the subjective experiences, firstly of victims, and not only of victims but also of the offenders as well as the society at large, and on reasoning about these in terms informed by empiricism, that is, the human mind as it is rather than as an abstract and arbitrarily malleable entity. My argument also draws strength from an examination of the relevant ontology, which I contend is presently confounded by linguistic limitations and, in particular, the confusion that is caused by the use of colloquial notions appropriate for everyday discourse but insufficiently philosophically nuanced for the ethics discussion at hand.…”

“…In particular, the suffering in this case originates in the difficulty, if not outright impossibility, of escape from conceiving us persisting as witnesses of the world without us, experiencing for eternity the denial of all the pleasures that real existence offers. The intensity of this suffering, much as I have previously shown to be the case with imprisonment, is highly individual, that is, it is contingent on one's personality and values, including those stemming from religious or spiritual views [18]. More importantly, and also like imprisonment, this intensity cannot be moderated otherwise than by time, i.e., by prolonging it, which makes capital punishment impermissible as a form of punishment on the same grounds, constraining its permissibility to the servicing of extreme incapacitation demands when it should on compassionate grounds be considered as more humane than decades-or lifetime-long incarceration.…”

Crime & Punishment: A Rethink

“…Indeed, in the present article I too advocate for the abandonment of imprisonment for punitive means, reserving its use for incapacitation of dangerous offenders (or, equivalently, the protection of their likely victims), which would have prisons change both in their nature and appearance, though on a philosophical basis quite unlike that of Zeki et al (2004). My overall thesis is premised on the basis which can be described as sentientist (Arandjelović, 2023b), centering on subjective experiences, firstly of victims, and not only of victims but also of the offenders as well as the society at large, and on reasoning about these in terms informed by empiricism, that is the human mind as it is rather than as an abstract and arbitrarily malleable entity. My argument also draws strength from an examination of the relevant ontology which I contend is presently confounded by linguistic limitations and, in particular, the confusion which is caused by the use of colloquial notions, appropriate for everyday discourse but insufficiently philosophically nuanced for the ethics discussion at hand.…”

“…In particular, the suffering in this case originates in the difficulty, if not outright impossibility, of escape from conceiving us persisting as witnesses of the world without us, experiencing for eternity the denial of all the pleasures that real existence offers. The intensity of this suffering, much as I have previously shown to be the case with imprisonment, is highly individual, that is, it is contingent on one's personality and values, including those stemming from religious or spiritual views (Arandjelović, 2023b). More importantly and also alike imprisonment, this intensity cannot be moderated otherwise than by time, i.e.…”

Disease: An ill‐founded concept at odds with the principle of patient‐centred medicine

“…This specious ‘democratisation of disease’ may very well resonate with the present‐day zeitgeist wherein ‘democratisation’ is seen as a panacea to most social ills, 61 but it is in want of a morally grounding substance. What Glackin 42 describes as a ‘liberal’ approach, namely the call ‘not to impose one faction's views on all parties, but to negotiate as wide as possible a modus vivendi, which will allow all parties to proceed on a basis of respectful disagreement, and tolerable compromise’ is one that few would object to in general, but as even the handful of examples I described illustrate, this approach often does not result in a successful resolution 62 ; therein is the very terminus a quo of the present discussion and the need thereof. Focusing instead on grounding conditions, Glackin does not venture to answer this question, describing it as ‘a debate primarily of interest to philosophers’, while recognising that ‘it will have practical consequences’.…”