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:

Unawareness and cost-benefit analysis in PVS

Wade (1) explores the ethical issues associated with the withdrawal
of gastrostomy feeding in patients in a persistent vegetative state. I
agree with his statement that, "The main bone of contention is likely to
centre on justice - is it equitable to allocate so much scare resource to
one person who is unaware for most of the time?" A Christian ethical
perspective is far from universally accepted. It does, however, alter the
cost-benefit analysis and provide an alternative to the limited
utilitarian conclusion of this article.

Both the 'costs' and the 'benefits' of the equation are altered if
you accept the ethics of justice expressed by Jesus (2), "The King … will
say to those on his left, 'Depart from me you cursed into the fire
prepared for the devil and his angels. For I was hungry and you gave me
nothing to eat, I was thirsty and you gave me nothing to drink…'

"They also will answer, 'Lord, when did we see you hungry or thirsty
… and did not help you?'

"He will reply, 'I tell you the truth, whatever you did not do for
one of the least of these, you did not do for me.'

"Then they will go away to eternal punishment, but the righteous to
eternal life."

There is parallelism in that both groups are unaware of the spiritual
implications of the situation.

Dr Hugo van Woerden

18 Dan-y-deri, Bedwas, Gwent.
CF83 8HR

1 Wade DT . Ethical issues in diagnosis and management of patients
in the permanent vegetative state. BMJ 2001;322:352-4.

2 The Holy Bible, New International Version. Matthew 25:41-6. New
York: New York Bible Society International, 1978.

Competing interests: No competing interests

18 February 2001
Hugo van Woerden
Specialist Registrar in Public Health Medicine
Bro-Taf Health Authority, Wales