The Fading "Bright Line" of Consciousness In Life & Death Decisions

E. Christian Brugger
& 2011 Culture of Life Foundation
Reproduced with Permission
Culture of Life Foundation

Most philosophical arguments against the personhood of embryos, fetuses or comatose patients focus on consciousness as the capacity that corresponds to the possession of moral value. Conscious human beings, even minimally conscious, are obviously 'one of us' - have interests, feel pain, perceive objects, and can offer at least rudimentary gestures of self-report. Since they are "persons" they should not be subjected to purely instrumental treatment such as lethal experimentation or deadly dosages of drugs. Those who cannot exercise consciousness are either not yet persons (e.g., embryos) or no longer persons (e.g., irreversibly comatose patients).

In end-of-life issues, all the high profile "merciful starvation" debates of the last few decades have concerned patients who have lost the capacity for consciousness (e.g., Karen Ann Quinlan, Nancy Cruzan, Terri Schiavo, Aruna Shanbaug, and Tony Bland in the U.K.). Recall the pictures of Terri Schiavo gazing up fixedly from her bed. Defenders of her starvation insisted that her fitful states of wakefulness were reflex behaviors devoid of conscious awareness, as if the question of life and death hinged on whether she was ever conscious. Opponents replied: "starving living human beings is wrong whether or not they are ever conscious."

How does the secular mind deal with patients who are less than fully conscious? Are they less than fully human? If their capacity for conscious experience is compromised through severe disability, are their lives as valuable as those who are full-bodied and strong? Would it be merciful to starve one whose hope of returning to full consciousness has been lost? Euthanasia advocates, of course, have always argued that there are some lives that are 'not worth living.' But in the jurisprudence of medicine, cases dealing with the lawful withholding of life-sustaining care from patients whose preferences are not clearly stated have drawn the line at consciousness. That line is now fading.

A British judge was recently asked to decide whether the family of brain damaged woman-known only as M-should be allowed to withhold food and water and let her die. The 51-year-old woman, severely disabled since 2003, is not comatose, not in a PVS, and is not otherwise dying. She is very clearly conscious, but minimally so - "a minimally conscious state". Her nurses say she responds to music and conversation and even attempts to communicate with those around her.

But some of her caregivers believe that her life has lost all meaning: "What can she possibly get out of life?," M's sister asks. "She can't move, speak and she's fed through a tube. She can't even enjoy a cup of tea."

Her sister's distress is understandable. But her conclusion that M would be better off dead is terribly misguided. That's because the question, "What can M get out of life?" is misguided. It is true that most of life's meaning is wrapped up in the conscious pursuit of human goods, in friendship and knowledge, inner peace and harmony with God. But life's meaning is not exhausted by the purposeful pursuit of conscious goals. Even when consciousness has been lost, one great human good still remains: life. Traditional morality calls it the "intrinsic goodness of human bodily life." And that goodness stands as a moral barrier between every person and every intention to harm or kill him or her.

The life of a neurologically disabled baby, or child, or adult is still good and deserves nurture and care. Caring for those who are cognitively impaired is good for the disabled, good for their caregivers and good for the community.

M's life is good and should be protected from starvation.

But so too are M's conscious experiences, however minimal, of being cared for, listening to music and conversing with others. Is music less enjoyable to her because of her disability? Perhaps. But perhaps she enjoys it more. Can we qualify the value of experience based upon degree neurological ability? A recent study in the British Medical Journal Open concluded that the majority of Locked-In Syndrome patients (with complete paralysis of all voluntary muscles and yet at least minimally consciousness) are happy.

We've heard it before: death's in her 'best interest;' life is 'of no further benefit' to her. Since the Cruzan case in 1990 (and the Bland Case in 1993), PVS patients have been routinely deprived of food and water with the protection of the courts. There's no substantive ethical difference between these cases and the case of M.

But there is a symbolic difference. Even according to the liberal mind, deliberately bringing about the death of a conscious human being is killing someone-killing 'one of us'. If the person doesn't want to die, it's called murder. If he does, it's assisted suicide. Consciousness notwithstanding, the case of M is being framed as a simple case of the removal of life-support. Another watershed about to be breached.

There's little consolation in saying 'I told you so.' Pro-lifers have argued for years that all milestones short of fertilization are arbitrary. There is nothing bright about the line of consciousness: its onset and expression at the margins of life are both elusive; the organ development necessary for its actualization supplies no light-switch moment where after the final pieces of a hard-wired system are in place, consciousness 'turns on.' It is the gradual awakening of a multi-layered capacity-involving the concomitant interaction of anatomical, neurochemical, physiological (and environmental) factors-radically present from fertilization unfolding along the seamless line of development that begins when the entity begins and ends for most when bodily life ceases. In other words, there is no clear line of consciousness to draw. Those who set down the line as the fateful marker of personhood, have done so by fiat. And they erase the line, as we are now seeing, by the same arbitrary means.