Disorders of Consciousness: Ethical Implications in Diagnosis, Prognosis and Management

The first half of this chapter presents a taxonomy of Disorders of Consciousness (DOCs), which includes coma, the Vegetative State (VS) and the Minimally Conscious State (MCS). Difficulties in clinically assessing patients with disordered consciousness are described, including the reliability of current and potential diagnostic techniques, in order to establish that DOC diagnoses and prognoses are uncertain. The second half of this chapter addresses the ethics of managing DOC patients. The main end-of-life ethics issue is the withdrawal of artificial life support from DOC patients. In many jurisdictions, including England, it is legally permitted to withdraw artificial nutrition and hydration (ANH) from persistent VS patients in order to let them die. Should this be extended to MCS patients? It is argued that the decision to allow MCS patients to die should not turn on the fact that DOC diagnoses and prognoses are uncertain. Nonetheless, there are other grounds for extending permission to withdraw ANH to MCS patients; three are discussed, namely, autonomy, best interests, and futile treatment.