Withdrawal of Life-Sustaining Treatment in Prolonged Disorders of Consciousness
DOI:
https://doi.org/10.5281/zenodo.22686170Keywords:
disorders of consciousness, withdrawal of treatment, end-of-life decision-making, best interests, clinical ethicsAbstract
Decisions to withdraw clinically assisted nutrition and hydration from patients with prolonged disorders of
consciousness sit at the intersection of diagnostic uncertainty, contested procedural safeguards, and difficult
questions about whose values should govern an incapacitated patient's fate.
This commentary examines the 2018 shift, most visible in England and Wales, away from mandatory judicial
approval of uncontested withdrawal decisions, and the divided reaction it has produced among clinicians,
lawyers, and bioethicists.
It then surveys evidence that behavioral diagnosis of vegetative versus minimally conscious states remains
error-prone, and that functional neuroimaging has revealed covert awareness in some patients previously
judged unresponsive, complicating the evidentiary basis for withdrawal decisions.
We further examine the empirical and philosophical literature on reconstructing an incapacitated patient's
likely preferences, and engage with the disability-rights critique that best-interests reasoning in this field has
too readily absorbed contestable quality-of-life judgments.
We conclude that current safeguards -- second opinions, best-interests panels, family consensus, and
occasional judicial review -- remain defensible only as imperfect compromises under genuine diagnostic and
moral uncertainty, not as a settled resolution of the underlying ethical dispute.
Keywords: disorders of consciousness; withdrawal of treatment; end-of-life decision-making; best interests;
clinical ethics
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