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Resurrecting the "Useless Eater" Approach to Health Care: Don't Let Consciousness Get in the Way of the Dehydration Agenda

Posted Mar 29 2009 4:13pm
So, now that we know that many people thought to be unconscious--are actually awake and aware--some might think that would cause bioethicists to step back from the dehydration agenda. As I have long predicted, not on a bet! An article published in the Journal of Medicine and Philosophy by Oxford bioethicists Guy Kahane and the always crassly utilitarian Julian Saveulescu, makes it clear that demonstrable awareness should be no bar to ending the lives of these disabled patients.

This is a 22 page article, and I obviously can't post it all here, even if there weren't copyright issues. But here is the gist: From their article's abstract:

Neuroimaging studies of brain-damaged patients diagnosed as in the vegetative state suggest that the patients might be conscious. This might seem to raise no new ethical questions given that in related disputes both sides agree that evidence for consciousness gives strong reason to preserve life. We question this assumption... We argue that enjoyment of consciousness might actually give stronger moral reasons not to preserve a patient's life and, indeed, that these might be stronger when patients retain significant cognitive function.
Who are these conscious people who should die? Those in what has come to be called the mimial conscious state. From the body of the article (no link available, my emphasis):
Such patients have, at best, only the most rudimentary desires, and they clearly do not have enough sapience to enjoy most objective goods--the goods of friendship, knowledge, achievement, and the like. Do they at least have experiential interests?...It is, however, plausible to assume that such patients do feel pleasure and pain--that they do have experiential interests...

Would this, in itself, be a reason to keep this patient alive for as long as we can? ... Such a patient clearly benefits from going on living in the sense that this means that, over time, she will enjoy more experiential goods. But this patient does not possess self consciousness or a desire to go on living, and little to no psychological connectedness over time. It is thus not clear that she would be significantly harmed if her life ended earlier than was possible. And, given that, considerations of distributive justice may tell against continuing to sustain the life of such a patient at great cost.
They thus claim that even if Terri Schiavo wasn't in an unconscious state, she was killable:
In the final month of her life, the parents of Terry Schiavo insisted that she was in MCS, not VS. But we have argued that the discovery of consciousness in patients diagnosed as in VS hardly settles the ethical questions on the side of continuing life-sustaining treatment. If the patient is in the MCS, it might rather be that we have no or only weak reasons to sustain her life, and some further positive reasons not to sustain it.
But what about patients who can communicate and are clearly aware, sometimes called the "locked in state?" Their lives are even less worth living because of possible mental anguish!

Kahane and Saveulesku are resurrecting the odious concept of the useless eater. If they get their way, tens of thousands of people around the world will be dehydrated or lethally injected to death.
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