In response to Terry Rosell

John Carney
Vice President/Aging and End of Life
Center for Practical Bioethics
February 4, 2010

I appreciate to my colleague Terry Rosell’s introspective narrative on the ethical impact of Monti’s (et.al) study on brain activity in disorders of consciousness. My take, however, is far more tentative and less personal.

The implication for ethics, I agree reinforces the critical importance of appointing an agent and making your wishes known to that person. On the other hand, the implications for state policy could only heighten anxiety and advocacy from life protection and disability rights groups - emphasizing the state’s interest in protecting patients who cannot speak for themselves.

That’s not a bad thing. We don’t know nearly as much about how the brain functions as we do other organs of the body. As we move away from the “heart” embodying the notion of personhood to that of the “brain”, it only makes this issue all the more confounding.

What I like about Terry’s argument is that he sets his judgment about the nature of his physical condition and ability to “be human” within the context of time and place, recognizing that the state of the science of medicine and its ability to explain and treat his condition are part of the meaning he gives his life. Our ability to understand and treat conditions is a function of our place in history.

His physical well being and his appreciation of what it means to be fully human is subject to that experience as well.

If medicine cannot help improve his condition but only prolongs his temporal, indefinite and mechanical path to death then what purpose does medicine serve? Does ongoing treatment offer benefit if its imposition only subjects him to further health risks? Is that help or harm?

If the latter, we all know that above all else we should do no harm.

On the other hand it is possible that someone could believe she could reconcile being “locked in” to an indefinite transcendent experience or as a redemptive act of longsuffering.

We certainly would not then judge her life as unworthy. I wouldn’t, especially if she spent her time praying for me.