1. Personhood and Persistent Vegetative State

2. What Is PVS? n Permanent unconsciousness n NOT coma-- sleep wake cycles n Random movements n No purposeful movements n Cannot perceive any environmental stimuli (including pain) n Spontaneous breathing after initial phase

3. What is PVS? Cont. n Brain stem intact n Cerebral hemispheres irreversibly damaged n No single sign is conclusively diagnostic n Can be diagnosed with confidence 1-12 months after initial injury depending on age, nature of injury

4. Persistent Vegetative State = Higher Brain Death

5. Cerebrum Brain stem Cerebellum

6. PVS vs. Whole brain death n Legally alive n Loss of cerebral function only n Permanently unconscious n Can maintain for up to 37 years n Rare cases of some recovery n Legally dead n Loss of cerebral + brain stem n Permanently unconscious n Can maintain for up to 3 months n No cases of any recovery

7. PVS vs. Whole brain death n Not truly a type of “coma” n Spontaneous respiration n Sleep-wake cycles n Various reflexes but no purposeful movement n No clear list of tests n Deepest possible coma n No spontaneous respiration n No sleep-wake cycles n Spinal reflexes only n Unambiguous diagnosis

8. Importance of Personhood n Basic moral ideal: respect for persons n In almost all cases, a living human being is a person n Borderline cases –Human fetus –PVS –Anencephalic infant

9. Mental capacity view of personhood n Favored by Arras and many others n Person = potential bearer of rights and interests n To have interests it must make a difference to you for your own sake what is done to you n To make a difference must have minimal level of awareness

10. Mental capacity n If one irreversibly lacks that minimal level of awareness of self and surroundings, not a “person” in the strict moral sense n Applies clearly to PVS: Former person, no longer one n Applies clearly to anencephalic infant: never can become a person

11. Risks? n “Nonperson” status in past often used as mode of discrimination against minorities (Nazis, etc.) n Reply: Mental capacity is different because it clearly made a difference to victims of Nazis what happened to them n Test: what would I want done to and for myself, if I were later to enter a PVS?

12. Criterion for death? n Proposal: We care about the deaths of persons, not about the deaths of human bodies n Therefore should have higher brain not whole brain criterion for death n Practical problem: ease and certainty of diagnosis

13. A differing (religious) view n All living human beings are worthy of respect and dignity n Ongoing life is always a “benefit” n A feeding tube thus provides a benefit with very little if any burden n PVS is an extreme disability so nontreatment mean treating the disabled as less than full persons