Article

The aims of this paper are to discuss three different ethical
frameworks; to briefly consider some of the philosophical positions concerning
the nature of personhood.
Clear consideration of these issues demonstrates the
complexity of decision making in persisting disorders of consciousness. METHOD:
Three different ethical frameworks, Kantian deontology, act utilitarianism and
rule utilitarianism, are described and three different accounts of personhood are
presented and analysed. RESULTS: These result in very different approaches to the
management of patients in permanent vegetative states (PVSs), making it possible
to argue for withdrawal of clinically assisted nutrition and hydration in all
cases, considering the issues on a case by case basis or continuing to treat all
patients whatever their wishes. CONCLUSIONS: These results explain why doctors
often have different views on how to treat patients in PVS, particularly with
regard to the withdrawal of clinically assisted nutrition and hydration.
Understanding such issues may help clinicians articulate more clearly the reasons
for their intuitions surrounding the management of patients in PVSs. Implications
for Rehabilitation Patients with persisting disorders of consciousness pose
significant dilemmas for clinicians and family members.
Utilitarianism is a
consequentialist theory, that is, it is concerned with the outcome of our actions
to determine their morality. It is the concept that the right action is the one
that will result in "the greatest amount of good for the greatest number".
Deontological ethics suggests that there are certain sorts of acts that are wrong
in themselves independent of the result of such actions. Personhood can be
approached from a variety of perspectives including biological, relational,
religious and psychological. Understanding different ethical frameworks, and the
nature of personhood, may help clinicians articulate more clearly the reasons for their intuitions.

Langue : ANGLAIS