When information on a coma patient’s expected outcome is uncertain, a moral dilemma arises in clinical practice: if life-sustaining treatment is continued, the patient may survive with unacceptably poor neurological prospects, but if withdrawn a patient who could have recovered may die. Continuous electroencephalogram-monitoring is expected to substantially improve neuroprognostication for patients in coma after cardiac arrest. This raises expectations that decisions whether or not to withdraw will become easier. This paper investigates that expectation, exploring cEEG’s impacts when it becomes (...) part of a socio-technical network in an Intensive Care Unit. Based on observations in two ICUs in the Netherlands and one in the USA that had cEEG implemented for research, we interviewed 25 family members, healthcare professionals, and surviving patients. The analysis focuses on the way patient outcomes are constructed, the kind of decision support these outcomes provide, and how cEEG affects communication between professionals and relatives. We argue that cEEG can take away or decrease the intensity of the dilemma in some cases, while increasing uncertainty for others. It also raises new concerns. Since its actual impacts furthermore hinge on how cEEG is designed and implemented, we end with recommendations for ensuring responsible development and implementation. (shrink)

Some brain injured patients are left in a permanent vegetative state, i.e., they have irreversibly lost their capacity for consciousness but retained some autonomic physiological functions, such as breathing unaided. Having discussed the controversial nature of the permanent vegetative state as a diagnostic category, we turn to the question of the patients’ ontological status. Are the permanently vegetative alive, dead, or in some other state? We present empirical data from interviews with relatives of patients, and with experts, to support the (...) view that the ontological state of permanently vegetative patients is unclear: such patients are neither straightforwardly alive nor simply dead. Having defended this view from counter-arguments we turn to the practical question as to how these patients ought to be treated. Some relatives and experts believe it is right for patients to be shifted from their currently unclear ontological state to that of being straightforwardly dead, but many are concerned or even horrified by the only legally sanctioned method guaranteed to achieve this, namely withdrawal of clinically assisted nutrition and hydration. A way of addressing this distress would be to allow active euthanasia for these patients. This is highly controversial; but we argue that standard objections to allowing active euthanasia for this particular class of permanently vegetative patients are weakened by these patients’ distinctive ontological status. (shrink)

Opposition to induced abortion rests on the belief that fetuses have a moral status comparable to beings like us, and that the loss of such a life is tragic. Antiabortion, or pro-life, theorists argue that (1) it is wrong to induce abortion and (2) it is wrong to allow others to perform induced abortion. However, evidence suggests that spontaneous abortion kills far more fetuses than induced abortion, and critics argue that most pro-life theorists neglect the threat of spontaneous abortion and (...) ought to do more to prevent it. Friberg-Fernros contends such an obligation would be implausibly strong, arguing that induced abortions are far worse than spontaneous abortions because while both involve the tragedy of the death of the fetus, induced abortion involves a second tragedy—one person killing another. I argue this two tragedies argument fails to explain what is morally relevant about induced abortion. (shrink)

ABSTRACT It is commonly assumed that the view that passive euthanasia is morally preferable to active euthanasia is an implication of the view that killing someone is worse than merely letting her die, and that it is held by its proponents on this ground. Accordingly, attempts to discredit the former often take the form of attempted refutations of the latter. In the present paper, it is argued that such attempts are misguided, since the former view is not in fact implied (...) by the latter. (shrink)