April 11, 2012 (LifeSiteNews.com) – If an American bioethicist gets her way, all patients evaluated as being in a “permanent vegetative state” (PVS) would by default have artificial nutrition and hydration (ANH) withdrawn unless they have made a prior wish to be kept alive.
In the March 2012 issue of Bioethics, Dr. Catherine Constable argues that “in the absence of clear evidence that the patient would opt for this existence over death, keeping him alive by any means of assistance is ethically more problematic than allowing him to die.”
Constable’s article however, does not appear to adequately confront recent research indicating that many patients have been misdiagnosed as PVS and have in fact had functioning, fully conscious brains. They have been unable to communicate their situation to caregivers and to those who in many cases made misguided decisions to end their lives. The highly respected Discover Magazine published a dramatic report on such research last year.
The term PVS itself is also being increasingly being challenged as inappropriate for human beings who it is argued can never be considered to be “vegetative”.
In her article titled Withdrawal of Artificial Nutrition and Hydration for Patients in a Permanent Vegetative State: Changing Tack, Constable suggests that the current medical presumption that favors providing nutrition and hydration to PVS patients is a “violation of autonomy” and that it “goes against the best interests of the patient”.
Constable, who teaches at New York University School of Medicine but who studied bioethics at the Ethox Centre at Oxford University, justifies her position using the philosophical premise of Peter Singer that “[whether or not] a being is human, and alive, does not in itself tell us whether it is wrong to take that being’s life.” She drew heavily on Singer’s method for valuing persons in terms of consciousness that allows him to argue that “the most significant ethically relevant characteristic of human beings whose brains have ceased to function is not that they are members of our species, but that they have no prospect of regaining consciousness.”
“Without consciousness, continued life cannot benefit them [PVS patients],” Singer argued.
Constable runs with Singer’s line of reasoning, concluding that “a decision to preserve the life of a patient in a state of permanent unconsciousness based on respect for life itself is morally no more sound than a decision to take that life.”
For Constable, an individual’s autonomy is the highest human good, overriding any other good, including what she calls the “sanctity of life”. Since a PVS patient presumably no longer has consciousness and therefore lacks autonomy, her argument runs, then there is no moral reason that such a patient should be kept alive.
“In view of this conclusion, other considerations, such as the cost to the healthcare system (public, or any other kind) would seem poised to be deciding factors,” she argues.
Constable goes as far as making the case that those who provide a PVS patient who may not have wanted to be kept alive with ANH “have arguably committed a worse violation of autonomy by treating the patient than if we had not treated him against his wishes.”
Bringing in surveys that indicate that a majority of people would not want to continue living in a permanent vegetative state, Constable argues that in continuing to provide ANH to PVS patients “we are employing a treatment that most do not consider beneficial without consent.” For Constable, ANH is simply a “form of treatment” that is concomitant with all the “ethical ramifications” that would normally accompany any other kind of treatment.
Constable even argues against keeping PVS patients alive through ANH under the pretext of a chance of recovery for the reason that the new life gained would be “far less likely to resemble [the life that was] lost” and would likely resemble “some state of middle consciousness”. She suggests that the life of a recovered PVS patient would be “quite possibly, worse than non-existence”.
Renowned bioethics critic Wesley J. Smith called Constable’s position paper a “radical proposal” that would set the stage for what he called a “‘default for death’ policy [that] would establish the foundation for a veritable duty to die”.
Smith warned that Constable’s arguments for killing PVS patients are not limited to the PVS.
“Some bioethicists already claim that those with minimal consciousness have an interest in being made to die. And don’t forget Futile Care Theory and health care rationing bearing down on us.”
The Vatican’s Congregation for the Doctrine of the Faith (CDF) stated in 2007 that the withdrawal of artificial nutrition and hydration from PVS patients is immoral. Their statements were approved by Pope Benedict XVI.
“The administration of food and water even by artificial means is, in principle, an ordinary and proportionate means of preserving life. It is therefore obligatory to the extent to which, and for as long as, it is shown to accomplish its proper finality, which is the hydration and nourishment of the patient. In this way suffering and death by starvation and dehydration are prevented.”
The CDF clarified that even if a competent physician judges with moral certainty that a PVS patient will never recover consciousness, nonetheless, a PVS patient is “a person with fundamental human dignity and must, therefore, receive ordinary and proportionate care which includes, in principle, the administration of water and food even by artificial means.”
The late John Paul II had also taught that “the administration of water and food [to a sick person], even when provided by artificial means, always represents a natural means of preserving life, not a medical act.”
“We had better push back on this agenda”, warned Smith on his blog.
“The lives of tens of thousands of people may be at stake.”