An Ethics of Welfare for Patients Diagnosed as Vegetative With Covert Awareness

Abstract

Recent research suggests that a minority of patients diagnosed as vegetative using traditional behavioral assessments may be covertly aware. One of the most pressing concerns with respect to these patients is their welfare. This article examines foundational issues concerning the application of a theory of welfare to these patients, and develops a research agenda with patient welfare as a central focus. We argue that patients diagnosed as vegetative with covert awareness likely have sentient interests, and because sentient interests are sufficient for moral status, others have an obligation to take the welfare interests of these patients seriously. However, we do not view sentient interests as necessary for moral status, and thus it is possible that vegetative patients who lack such interests have moral status for other reasons. We propose four areas in which future research is needed to guide the ethical treatment of these patients: the assessment and management of pain; the development of quality of life assessments; end-of-life decision making; and enriching the day-to-day lives of these patients.

Welfare in the Medical Profession: A Response to Graham and Colleagues

“…3 As long as the patient population includes the nonsentient, the nonconscious, and the nonself-aware, and as long medical professionals continue to claim that these patients fare well or poorly despite their lack of certain functions, the medical profession need not entertain sentience, consciousness, or self-awareness as necessary conditions for welfare. The authors, on the other hand, offer an account of patient welfare that cites sentience as a sufficient condition for moral status (Graham et al 2015). This is compatible with the practices of the medical profession.…”

“…Neurology 58 (3): 349-353 Available at: http://www.neurology.org/content/58/3/ 349.long (accessed February 14, 2015). http://dx.doi.org/10.1212/ WNL.58.3.349 Graham, M., C. Weijer, D. Cruse, et al 2015. An ethics of welfare for patients diagnosed as vegetative with covert awareness.…”

Alive inside

“…NEJM, 352 (16), 1630-1633. 31 Peterson, A., Cruse, D., Naci, L., Weijer, C., & Owen, A. M. (2015). Risk, diagnostic error, and the clinical science of consciousness.…”

Using neuroimaging to uncover awareness in brain-injured and anesthetized patients

“…Like AAGA patients, CMD patients exemplify the notion that loss of behavioral responsiveness does not guarantee loss of consciousness. Indeed, in both cases, this mistaken assumption can result in significant harm to the patient (8)(9)(10)(11)(12)(13). Accordingly, there is a need for increased accuracy of assessments that can detect covert awareness in both patient groups.…”