Can Patients with Disorders of Consciousness Be Wronged?

Abstract: It’s commonly assumed that the most morally significant question bearing on the treatment of patients with disorders of consciousness (DOC) is whether they are still capable of experiencing (hence, sustaining) benefits and harms. The assumption is, roughly, that a person can be treated wrongly only if she can be harmed by that treatment, and that she can be thereby harmed only if she has the capacity for conscious experience. We argue that this claim—the consciousness condition—is false. People can be wronged directly even if they permanently lack consciousness and thus have no ability to experience benefit or harm. Our argument rests on the intuition that it is wrong to subject comatose female patients to unauthorized pelvic examinations for the purpose of training medical students and other trainees. Because these patients lack consciousness entirely, however, they experience (hence, sustain) no harm, so harmfulness cannot be what makes these acts wrong. Instead, we propose that what explains the wrong in play is that such acts amount to treating these patients as mere objects, not as human beings—in particular, as tools or resources for the benefit of others. We argue that our objectification account better characterizes the wrong of subjecting DOC patients to unauthorized pelvic examinations for training purposes than competing views, including: appeals to the practice’s alleged harmfulness (by way of diagnostic uncertainty and precautionary considerations), disrespect for precedent autonomy, and even human dignity. Our argument therefore suggests that feminist discussions of sexual objectification are vitally relevant to neuroethics.

Nada Gligorov – Albany Medical College