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฀ 171 13 Should฀Nutrition฀and฀Hydration฀Be฀Provided฀ to฀Permanently฀Unconscious฀and฀Other฀ Mentally฀Disabled฀Persons? Germain฀Grisez The฀title฀of฀this฀article฀can฀be฀understood฀either฀as฀a฀legal฀or฀as฀an฀ethical฀question .฀I฀treat฀it฀here฀only฀insofar฀as฀it฀is฀an฀ethical฀question—that฀is,฀a฀moral฀issue .1 ฀But฀I฀hope฀my฀treatment฀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.฀For฀ 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,฀my฀aim฀in฀writing฀this฀article฀is฀not฀to฀try฀to฀use฀ideas฀and฀words฀to฀ channel฀anyone’s฀behavior,฀but฀to฀articulate฀my฀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. I฀did฀not฀formulate฀the฀title฀of฀this฀article,฀but฀accepted฀it฀as฀a฀question฀put฀ to฀me.฀I฀take฀“permanently฀comatose”฀to฀refer฀to฀all฀who฀are฀in฀fact฀permanently฀ unconscious,฀no฀matter฀what฀their฀specific฀condition฀or฀its฀underlying฀cause.2 ฀I฀ presuppose฀here฀that฀even฀comatose฀human฀individuals฀are฀persons.3 For฀brevity’s฀sake,฀I฀shall฀use฀the฀single฀word฀ “comatose”฀to฀refer฀to฀the฀ permanently฀unconscious,฀and฀the฀single฀word฀“food”฀to฀refer฀to฀nutrition฀and฀ hydration. For฀the฀purpose฀of฀this฀article,฀I฀set฀aside฀two฀types฀of฀cases: First,฀sometimes฀a฀choice฀is฀made฀to฀kill฀someone,฀and฀that฀choice฀is฀carried฀ out฀by฀withholding฀food.฀(It฀seems฀to฀me฀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,฀I฀believe,฀is฀homicide฀and฀cannot฀ be฀morally฀justified.฀I฀have฀argued฀for฀this฀view฀elsewhere฀and฀shall฀take฀it฀for฀ granted฀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,฀and฀perhaps฀ even฀will฀increase฀discomfort.฀I฀agree฀with฀what฀seems฀to฀be฀a฀general฀consensus฀ that฀in฀such฀cases฀food฀should฀not฀be฀provided.฀For,฀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,฀and฀therefore,฀when฀doing฀so฀is฀no฀benefit,฀and฀perhaps฀is฀a฀ burden,฀it฀is฀not฀reasonable฀to฀continue฀trying฀to฀provide฀food. 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. I฀also฀set฀aside฀the฀method฀of฀feeding฀called฀“total฀parenteral฀feeding”฀or฀ “hyperalimentation.”5 ฀It฀differs฀significantly฀in฀its฀burdens฀from฀other฀methods฀ of฀feeding฀and฀is฀used฀in฀few฀if฀any฀cases฀to฀sustain฀comatose฀persons.฀So,฀I฀do฀ not฀consider฀it฀relevant฀to฀the฀general฀question฀to฀be฀treated฀here. In฀1986฀I฀published฀a฀lecture฀in฀which฀I฀dealt฀with฀the฀part฀of฀the฀issue฀bearing ฀on฀comatose฀persons.฀In฀that฀lecture,฀I฀said: 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.฀These฀do฀not฀include฀feeding฀ by฀tube,฀and฀Miss฀Quinlan฀could฀not฀be฀fed฀otherwise.฀Thus,฀if฀I฀am฀right,฀she฀ should฀not...

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