Should Dehydration be Default for PVS?

In all the screaming about “after-birth abortion,” another radical bioethics paper was published in the journal Bioethics. Rather than the benefit of doubt going to life in cases of diagnosed persistent unconsciousness, the author—a medical resident who received bioethics training at Oxford—says that the default should be dehydration.  I mentioned this briefly here. But decided to expound more fully for the Center for Bioethics and Culture Network.  From “Should Dehydration Be the Default Decision for PVS?”:

The question concerns whether or not to provide such patients with food and water. Tube-supplied sustenance—called artificial nutrition and hydration (ANH)—is considered a form of medical treatment that can be withdrawn or withheld like any other medical care, such as antibiotics, chemotherapy, and indeed, aspirin. Of course, unlike withdrawing other treatments, ceasing to provide ANH results in the patient’s death in every case—usually over a 10-14 day period.

(Withdrawing such medically efficacious sustenance should not be confused with situations in which a patient’s body is actively shutting down during the dying process and the body can’t assimilate food or water. In such cases, ANH is medically inappropriate. The patient dies of their disease, not dehydration.)

Currently, the benefit of doubt in such cases falls on the side of life.  But the author, Catherine Constable, would reverse this:

How does she justify such a harsh measure? First, she denies PVS patients have an “interest” in living because (quoting Princeton bioethicist Peter Singer) “life cannot benefit them.” That being so, money rules:

We need not label these patients as already ‘dead’ or claim that withdrawing care is not the same as ‘taking life’ in order to find that it is difficult to apply any sort of ‘right to life’ argument to a patient who would not now or ever choose to exercise that right. In view of this conclusion, other considerations, such as the cost to the health care system . . . would seem poised to be deciding factors. Of course, such an argument could also be voiced in support of killing these helpless patients by harvesting their organs. Indeed, it already is—as I have discussed previously. But what about the people who unexpectedly wake up? Constable says most of these weren’t truly PVS—even though some had been so diagnosed. (In fact, studies show that PVS is misdiagnosed about 40% of the time.)

But that doesn’t matter because “the new life gained” by the “miracle patient” is “far less likely to resemble what he lost than to be some state of middle consciousness;” a life “quite possibly, worse than non-existence.” Moreover, the potential benefit of living to be a miracle patient “is not sufficient to trump the public interest in allocating resources to patients more likely to benefit.”

She creates a hedge that would permit families to countervail the dehydration, but that is less than it seems:

But if it is true that families now have to justify choosing to dehydrate, this radical shift would put families in the position of having to justify the continuance of food and fluids in the face of potentially hostile doctors, bioethicists, and the public policy of society. Families often already face too many such pressures. Creating a “default for death” policy would not only make matters worse, it would establish the foundation for a veritable duty to die.

By the way, if this view prevails, it won’t be limited to the PVS.  Some bioethicists already claim that those with minimal consciousness have an interest in being made to die. And don’t forget Futile Care Theory and health care rationing bearing down on us.  We had better push back on this agenda. The lives of tens of thousands of people may be at stake.