Artificial nutrition and hydration should normally be withdrawn, says doctor

An American doctor argues in the latest issue of the leading journal Bioethics that artificial nutrition and hydration should be withdrawn from all patients in a permanent vegetative state – unless there is clear evidence that they want to be kept alive.

Dr Catherine Constable, of New York University School of Medicine, studied bioethics at the Ethox Centre at Oxford University. She argues that the current presumption in favour of maintaining ANH is misguided. It is not in the interests of the patient nor, because of its cost, in the interest of society.

However, her argument is not based upon cost, but upon Peter Singer’s analysis of what it means to be a person. An individual in a PVS has no consciousness and therefore no interests. In this case, whether or not he or she is alive is irrelevant.

“Excluding any known wishes of the patient or family to the contrary, 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.”

Furthermore, surveys have shown that most people would not like to live as Terri Schiavo did. Therefore, in the absence of a living will, “we have arguably committed a worse violation of autonomy by treating the [PVS] patient than if we had not treated him against his wishes.”

What about the remote, but real, chance of recovery from a permanent vegetative state? Isn’t that hope an reason for keeping people alive? No, says Dr Constable. Even if they recover, it will be all but  impossible for them to return to normal life. Instead it will be “some state of middle consciousness; a life, quite possibly, worse than non-existence”. ~ Bioethics, March

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