Intended for healthcare professionals

Rapid response to:

Education And Debate

Ethical issues in diagnosis and management of patients in the permanent vegetative state

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7282.352 (Published 10 February 2001) Cite this as: BMJ 2001;322:352

Rapid Response:

Re: Mode of death in permanent vegetative state; human rights issues.

Dear Sir,

I thank Dr Woodcock for drawing attention to the fact that killing
someone with the primary intention of obtaining organs for transplantation
is both illegal and immoral.

However I was trying to make a different point, namely that the
autonomy of the patient (person in PVS) might be reduced by using a mode
of death that precluded use of their organs by others. If the individual
strongly believed that others should be able to use their organs after
death, then it is at least arguable that to enable a mode of death which
still allowed organs to be used would show them more respect than simply
allowing them to die from dehydration. Neither mode of death is ideal,
but one allows their wishes to be fulfilled and the other does not.

Thus I am suggesting that one should intend to maximise the
fulfilment of the patient's wishes, not the satisfaction of the needs of
Society. Of course it must also be recognised that positive killing has
negative aspects, such as distressing health professionals.

My article intended simply to point out that there are two or more
sides to each choice made in the management of patients in PVS. There is
no obvious correct choice, and after ten years of experience a further
debate is needed even if only to validate current practice.

Yours,

Derick Wade

Competing interests: No competing interests

22 February 2001
Derick T Wade
Consultant in Neurological Disability
Rivermead Rehabilitation Centre, Abingdon Road, Oxford OX1 4XD