Personhood and Persistent Vegetative StateWhat Is PVS?What is PVS? Cont.Persistent Vegetative State = Higher Brain DeathSlide 5PVS vs. Whole brain deathSlide 7Importance of PersonhoodMental capacity view of personhoodMental capacityRisks?Criterion for death?A differing (religious) viewPersonhood and Persistent Vegetative StateWhat Is PVS?Permanent unconsciousnessNOT coma-- sleep wake cyclesRandom movementsNo purposeful movementsCannot perceive any environmental stimuli (including pain)Spontaneous breathing after initial phaseWhat is PVS? Cont.Brain stem intactCerebral hemispheres irreversibly damagedNo single sign is conclusively diagnosticCan be diagnosed with confidence 1-12 months after initial injury depending on age, nature of injuryPersistent Vegetative State = Higher Brain DeathCerebrumBrain stemCerebellumPVS vs. Whole brain deathLegally aliveLoss of cerebral function onlyPermanently unconsciousCan maintain for up to 37 yearsRare cases of some recoveryLegally deadLoss of cerebral + brain stemPermanently unconsciousCan maintain for up to 3 monthsNo cases of any recoveryPVS vs. Whole brain deathNot truly a type of “coma”Spontaneous respirationSleep-wake cyclesVarious reflexes but no purposeful movementNo clear list of testsDeepest possible comaNo spontaneous respirationNo sleep-wake cyclesSpinal reflexes onlyUnambiguous diagnosisImportance of PersonhoodBasic moral ideal: respect for personsIn almost all cases, a living human being is a personBorderline cases–Human fetus–PVS–Anencephalic infantMental capacity view of personhoodFavored by Arras and many othersPerson = potential bearer of rights and interestsTo have interests it must make a difference to you for your own sake what is done to youTo make a difference must have minimal level of awarenessMental capacityIf one irreversibly lacks that minimal level of awareness of self and surroundings, not a “person” in the strict moral senseApplies clearly to PVS: Former person, no longer oneApplies clearly to anencephalic infant: never can become a personRisks?“Nonperson” status in past often used as mode of discrimination against minorities (Nazis, etc.)Reply: Mental capacity is different because it clearly made a difference to victims of Nazis what happened to themTest: what would I want done to and for myself, if I were later to enter a PVS?Criterion for death?Proposal: We care about the deaths of persons, not about the deaths of human bodiesTherefore should have higher brain not whole brain criterion for deathPractical problem: ease and certainty of diagnosisA differing (religious) viewAll living human beings are worthy of respect and dignityOngoing life is always a “benefit”A feeding tube thus provides a benefit with very little if any burdenPVS is an extreme disability so nontreatment mean treating the disabled as less than full