Rethinking persistent vegetative state and protection of those diagnosed as in it

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Aleshinloye, OB, 2021. Rethinking persistent vegetative state and protection of those diagnosed as in it. PhD, Nottingham Trent University.

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Abstract

Both the concept of PVS and the treatment of those defined as having it have been the subject of considerable discussion in the literature from a variety of disciplinary perspectives. This thesis, however, aims to push the field further forward with an approach that is more intensively multidisciplinary, holistic, and critical of orthodoxies with respect to the legitimacy of the PVS concept and withdrawal and withholding of life-sustaining interventions (WWLSI) from those labelled as being PVS. Through a unique empirical study, it deepens the understanding of how healthcare professionals working with patients defined as PVS see the condition and think about / practically approach the clinical, ethical, and legal issues relating to it, including WWLSI.

One of the critically reflected orthodoxies is the medical notion that PVS is a condition involving patients who are unconscious. The empirical aspect of the thesis suggests that there is a great deal of complacency around this notion. Yet closer consideration reveals several problems with it. Firstly, functional magnetic resonance imaging (fMRI) analysis of some patients deemed PVS appears to contradict the notion that they cannot per se communicate. Secondly, no study has demonstrated any direct link between consciousness and a specific neural process in the brain of those labelled 'PVS.' Indeed, as I show as part of an epistemological exploration of the PVS concept, there is, at least beyond the narrow confines of medical practice in this field, a great deal of debate and dispute over what consciousness is and how it relates to the brain. Thirdly, as some patients are being defined as having recovered from being vegetative (reflected in the P now generally being treated as standing for persistent rather than permanent), this gives rise to the question of whether they had actually lost consciousness only to recover it or whether they had never lost consciousness in the first place (with PVS thus being more of a communication disorder).

The uncritical orthodox position towards the PVS has played into a limited conception of the interests of those labelled PVS – including notions that they have no functional interests. I posit that this has spilled over into ethico-legal analysis of how they should be treated and the specific question of WWLSI. That analysis, however, is also greatly impacted by the ethical lenses it tends to be viewed through. Furthermore, this thesis details the main ethical lenses and makes the case for preferring one that reflects respect for human worth, grounded in a particular conception of respect for human dignity and personhood. I work through the implications of this approach on law and practice relating to the treatment of those diagnosed as PVS and the legitimacy of WWLSI from such patients in particular. Besides recommending that the parameters for diagnosing PVS should be revisited and making a case for changing the governance and practice of WWLSI in PVS, I also recommended further research into the relationship between the brain and consciousness in these patients and that the law and / or professional ethical codes should protect the unconscious.

Item Type:	Thesis
Creators:	Aleshinloye, O.B.
Date:	September 2021
Divisions:	Schools > Nottingham Law School
Record created by:	Linda Sullivan
Date Added:	15 Sep 2022 08:30
Last Modified:	15 Sep 2022 08:30
URI:	https://irep.ntu.ac.uk/id/eprint/47030