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13. Should Nutrition and Hydration Be Provided to Permanently Unconscious and Other Mentally Disabled Persons?
- Georgetown University Press
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171 13 ShouldNutritionandHydrationBeProvided toPermanentlyUnconsciousandOther MentallyDisabledPersons? GermainGrisez Thetitleofthisarticlecanbeunderstoodeitherasalegalorasanethicalquestion .Itreatithereonlyinsofarasitisanethicalquestion—thatis,amoralissue .1 ButIhopemytreatmentwillcontributetothecurrentdebateaboutwhat lawoughttorequireinthismatter.For,ofcourse,questionsaboutwhatlaw shouldrequireare,atleastinlargepart,moralquestions. Initsreflectiononmoralquestions,ethicshasataskverydifferentfromthat oflegalstudieswhichfocusonthemakingandapplicationofsocialrules.For ethicstriestodiscoverwhatisgoodandrightforpersonsandgroupsofpersons, consideredinsofarastheyareagents.Inotherwords,ethicstriestolearnthe truthaboutwhatwaysofactingwillmakepersonsandcommunitiestrulyflourish .Thus,myaiminwritingthisarticleisnottotrytouseideasandwordsto channelanyone’sbehavior,buttoarticulatemyownefforttoarriveatasound viewonthequestion,inthehopethatdoingsowillhelpotherswhowantto knowwhattheyoughttodoaboutit. Ididnotformulatethetitleofthisarticle,butaccepteditasaquestionput tome.Itake“permanentlycomatose”torefertoallwhoareinfactpermanently unconscious,nomatterwhattheirspecificconditionoritsunderlyingcause.2 I presupposeherethatevencomatosehumanindividualsarepersons.3 Forbrevity’ssake,Ishallusethesingleword “comatose”torefertothe permanentlyunconscious,andthesingleword“food”torefertonutritionand hydration. Forthepurposeofthisarticle,Isetasidetwotypesofcases: First,sometimesachoiceismadetokillsomeone,andthatchoiceiscarried outbywithholdingfood.(Itseemstomethatthisisexactlywhathasbeendone insomeofthewidelypublicizedcases.)Now,iffoodiswithheldpreciselyin ordertokillsomeone,thatcalculatedomission,Ibelieve,ishomicideandcannot bemorallyjustified.Ihavearguedforthisviewelsewhereandshalltakeitfor grantedhere.4 Second,sometimesacomatoseorothermentallydisabledpersonisdying, andprovidingfoodwillnotprolonglifeorgivethepersoncomfort,andperhaps evenwillincreasediscomfort.Iagreewithwhatseemstobeageneralconsensus thatinsuchcasesfoodshouldnotbeprovided.For,justasistrueofanyother sortofcareortreatment,thereasonforprovidingfoodistobenefittheperson beingcaredfor,andtherefore,whendoingsoisnobenefit,andperhapsisa burden,itisnotreasonabletocontinuetryingtoprovidefood. Thus,thisarticleconcernsonlycasesofthefollowingsort:nochoiceis madetokillthecomatoseorotherwisementallydisabledperson,thepersonis notdying,buttheburdensofcareanditslimitedbenefitsmakesomeorallof thoseconcernedwonderwhetheritisrighttocontinueprovidingfood. Ialsosetasidethemethodoffeedingcalled“totalparenteralfeeding”or “hyperalimentation.”5 Itdifferssignificantlyinitsburdensfromothermethods offeedingandisusedinfewifanycasestosustaincomatosepersons.So,Ido notconsideritrelevanttothegeneralquestiontobetreatedhere. In1986IpublishedalectureinwhichIdealtwiththepartoftheissuebearing oncomatosepersons.Inthatlecture,Isaid: Ifapatientisnotinimminentdangerofdeathbutisinanirreversiblecoma, asthelateMissKarenQuinlanwas,life-supportcaremoresophisticatedthan ordinarynursingcareisverycostly.Itseemstomethatsuchcostlycareexceeds apermanentlycomatoseperson’sfairshareofavailablefacilitiesandservices. Thus,IbelievethatwhenMissQuinlanwasremovedfromintensivecare,she oughtnottohavebeenplacedinaspecialcarefacility,butshouldinsteadhave beensenthomeorcaredforinthehospitalwithonlythesortsofequipment andservicesavailableinanordinaryhousehold.Thesedonotincludefeeding bytube,andMissQuinlancouldnotbefedotherwise.Thus,ifIamright,she shouldnot...