Do patients in a minimally conscious state have human dignity? This is the difficult question tackled by Dr Jukka Varelius, of the University of Turku, Finland, in the latest issue of the journal Neuroethics. He casts his net widely, because a minimally conscious state includes people in a "vegetative" state, but also people who show some signs of memory, attention and intention. Some of them recover, even after several years.

Dr Varelius is trying to make a philosophical point: that these patients have no human dignity because human dignity is a meaningless concept. He acknowledges that the view that we have moral duties to people in such a condition is "intuitively plausible". But he thinks that other qualities such as health, well-being, justice, and autonomy are better candidates for moral reasoning than human dignity.

This is a line of reasoning which has become more and more prominent since bioethicist Ruth Macklin’s 2003 article in the BMJ in 2003, "Dignity Is a Useless Concept". Dr Varelius, however, gives a more extended argument against human dignity and tries to show that neither rationality nor potential for rationality is a good grounds for human dignity. Nor is the evolutionary argument that we are members of the same species. Nor is the fact that they are persons. Nor are any beliefs which rely upon God or religion. "Consequently, -- he concludes -- in the light of the main argument of this paper, the view that persons in minimally conscious state have human dignity lacks sufficient rational grounds." ~ Neuroethics,