The Moral Status and Welfare of Patients Diagnosed as Vegetative With Covert Awareness

Several neuroimaging studies have demonstrated that a minority of patients diagnosed as being in the vegetative state are able to modulate their brain activity in response to the commands of researchers, thus demonstrating that they are ‘covertly aware.’ I examine the moral significance of this discovery, with a specific focus on the implications for patient welfare. I argue that the presence of awareness in these patients is important because it allows for the presence of sentience—the capacity for suffering and enjoyment—which I argue is a sufficient condition for moral status. Insofar as these patients have moral status, their interests matter morally; we have an obligation to give them proper consideration in our decision making. I present empirical evidence which supports the assumption that patients diagnosed as vegetative with covert awareness are sentient, and thus have moral status. I then consider an account of the welfare of these patients, which incorporates three traditional conceptions of welfare—hedonism, desire-satisfaction, and objective theories—and concludes that these patients are faring poorly, such that we may have a moral obligation to end their lives. I analyse and ultimately reject this conclusion. I argue that the application of traditional theories of welfare to these populations is impeded by a lack of knowledge of their subjective experiences, as well as challenges to the conceptions of welfare themselves. I then propose a novel approach for assessing the welfare of these patients, based on their subjective experiences. This approach involves extrapolating from the reported welfare interests of similar patient populations, as well as making plausible inferences about the residual cognitive capacities of these patients, based on the results of novel neuroimaging studies. Using these two sources of information, we can begin to construct a clearer picture of the welfare of these patients, and work to ensure that they have a decent quality of life