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Why Withdrawal of Life-Support for PVS Patients is Not a Family Decision

Published online by Cambridge University Press:  29 April 2021

Charles H. Baron
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Extract

We presently are not really leaving withdrawal of treatment decisions to families and there are good reasons why we ought not to do so. To see why this is, we need to focus on what is special about PVS cases as opposed to other kinds of medical cases in which we are forced to make life and death decisions.

One thing which is very special about PVS is the fact that it is a condition which intuitively pushes us to rethink, once again, society's definition of “death.” We have already changed our definitions of death to include situations in which respiration and circulation continue but the “whole brain” is dead. Defining death to include irreversible PVS would merely require extending the definition to include situations where the brain stem is functioning but the neocortex is dead. There are, of course, obstacles to overcome in extending the definition in that fashion.

Type
Article
Information
Law, Medicine and Healthcare , Volume 19 , Issue 1-2 , Spring Summer 1991 , pp. 73 - 75
Copyright
Copyright © American Society of Law, Medicine and Ethics 1991

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References

See Wikler, D., “Not Dead, Not Dying? Ethical Categories and Persistent Vegetative State,” Hastings Center Report, February/March 1988, at 41.Google Scholar
See Cranford, R., “The Persistent Vegetative State: The Medical Reality (Getting the Facts Straight),” Hasting Center Report, February/March 1988, at 27, and Cranford, R. Smith, H., “Some Critical Distinctions Between Brain Death and Persistent Vegetative State,” 6 Ethics in Science and Medicine 199 (1979).Google Scholar
Cranford, R. Smith, D., “Consciousness: The Most Critical Moral (Constitutional) Standard For Human Personhood,” 13 Am. J. L. & M. 233, 236 (1987).Google Scholar
“Right to Die: The Public's View,” The New York Times, June 26, 1990, section A, p. 18, Col. 2.Google Scholar
See Council on Scientific Affairs and Council on Ethical and Judicial Affairs, American Medical Association, “Persistent Vegetative State and the Decision to Withdraw or Withhold Life Support,” 263 J.A.M.A. 426 (1990).Google Scholar
See, for example, National Conference of Commissioners on Uniform State Laws, “Uniform Rights of the Terminally Ill Act” (1989).Google Scholar
Comm. v. David & Ginger Twitchell, Docket Nos. 069517 and 069757, (Superior Ct., Suffolk County Mass., May 1990).Google Scholar
Compare Matter of Westchester County Medical Center [O’Connor], 531 N.E.2d 607 (N.Y. 1988), with Elbaum v. Grace Plaza, 148 A.D.2d 244 (N.Y. 1989).Google Scholar
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Compare In Re Conroy, 486 A.2d 1209 (N.J. 1985) with In Re Peter, 529 A.2d 419 (N.J. 1987) and In Re Jobes, 529 A.2d 434 (N.J. 1987). In the last-cited case, the New Jersey Supreme Court candidly observes: “Because of the unique problems involved in decision making for any patient in the persistent vegetative state, we necessarily distinguish their cases from cases involving other patients. Accordingly, in Peter we held that neither the life expectancy test nor the balancing tests set forth in Conroy are appropriate in the case of a persistently vegetative patient.” 529 A.2d 434, at 443Google Scholar