Personhood and Persistent Vegetative State

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Personhood and Persistent Vegetative State
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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

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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

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Persistent Vegetative State Higher Brain Death
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Cerebrum
Brain stem
Cerebellum
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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

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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

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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

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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

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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

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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?

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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

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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