Should Nutrition and Hydration be Provided to Permanently Comatose and Other Mentally Disabled Persons?

Abstract

The title of this article can be understood either as a legal or as an ethical question. It is treated only insofar as it is an ethical question--that is, a moral issue.(1) But it is the author's hope that this discussion will contribute to the current debate about what law ought to require in this matter, for, of course, questions about what law should require are, at least in large part, moral questions. In its reflection on moral questions, ethics has a task very different from that of legal studies, which focus on the making and application of social rules. Ethics tries to discover what is good and right for persons and groups of persons, considered insofar as they are agents. In other words, ethics tries to learn the truth about what ways of acting will make persons and communities truly flourish. Thus, the aim of this article is not to try to use ideas and words to channel anyone's behavior, but to articulate the author's own effort to arrive at a sound view on the question, in the hope that doing so will help others who want to know what they ought to do about it. Permanently is understood to refer to all who are in fact permanently unconscious, no matter what their specific condition is or its underlying cause.(2) The author presupposes that even comatose human individuals are persons.(3) For brevity's sake, the single word comatose shall be used to refer to the permanently unconscious, and the single word food to refer to nutrition and hydration. For the purpose of this article, two types of cases are excluded from the discussion: First, sometimes a choice is made to kill someone, and that choice is carried out by withholding food. It seems that this is exactly what has been done in some of the widely publicized cases. Now, if food is withheld precisely in order to kill someone, that calculated omission is homicide and cannot be morally justified. The author has argued this view elsewhere and shall not repeat those arguments here.(4) Second, sometimes a comatose or other mentally disabled person is dying, and providing food will not prolong life or give the person comfort, but perhaps even will increase discomfort. The author agrees with the general consensus that in such cases food should not be provided. Just as is true of any other sort of care or treatment, the reason for providing food is to benefit the person being cared for; therefore, when doing so is no benefit, and perhaps is a burden, it is not reasonable to continue trying to provide food. Also set aside is the method of called total parenteral feeding or hyperalimentation.(5) It differs significantly in its burdens from other methods of and is used in few if any cases to sustain comatose persons. So, it is not considered relevant to the general question to be treated here. Thus, this article concerns only cases of the following sort: no choice is made to kill the comatose or otherwise mentally disabled person, the person is not dying, but the burdens of care and its limited benefits make some or all of those concerned wonder whether it is right to continue providing food. A Change of Mind In 1986, the author published a lecture which dealt with the issue of persons who are comatose. That lecture stated: If a patient is not in imminent danger of death but is in an irreversible coma, as the late Miss Karen Quinlan was, life-support care more sophisticated than ordinary nursing care is very costly. It seems to me that such costly care exceeds a permanently comatose person's fair share of available facilities and services. Thus, I believe that when Miss Quinlan was removed from intensive care, she ought not to have been placed in a special care facility, but should instead have been sent home or cared for in the hospital with only the sorts of equipment and services available in an ordinary household. …