Suffering, the Unconscious and the Application of Dignity: What is the Science, What are the Ethics?

Here is an extract of a current news item from Associated Press which raises important scientific and ethical issues: Can a patient who is seemingly unconscious in a permanent vegetative state suffer? To whom is dignity applied if a patient is kept alive against their wishes, the patient or others?

ROME— Pope Benedict XVI on Saturday [February 7 2009] affirmed the need to protect life even while suffering, making a last-minute intervention as Italy grapples with a fiercely debated right-to-die case.
Eluana Englaro, 38, has been in a vegetative state for 17 years after a car crash. On Friday, after a decade-long court battle, her nutrition began to be reduced in preparation for removing her feeding tubes, which her father has said was her wish.
Benedict didn't refer by name to Englaro in his message Saturday for the annual World Day of the Sick. But the pope said he wanted to reaffirm with vigor "the absolute and supreme dignity of every human being" even when "weak and shrouded in the mystery of suffering."

This case, is now involving the political system of Italy with the Premier and his party attempting, against the opinion of the Italian President and the decision of the Italian courts to create a law to prevent the doctors from removing the feeding tubes. Shades of Terri Schiavo in the United States!

The issue can also involve the question of “what does the word ‘suffering’ really mean?" And in the case of a patient in persistent vegetative state with a family, who is actually suffering, the patient or the family or both? And if tube feedings are continued in the patient so that the patient can continue to be alive for whom is the “dignity” of further feeding being attended to, the patient or really the family?

With regard to the definition and use of the word ‘suffering’ and its associated or independent word ‘pain’, there is a very good description in Wikipedia starting with “Suffering, or pain is an individual's basic affective experience of unpleasantness and aversion associated with harm or threat of harm. Suffering may be qualified as physical, or mental. It may come in all degrees of intensity, from mild to intolerable. Factors of duration and frequency of occurrence usually compound that of intensity. In addition to such factors, people's attitudes toward suffering may take into account how much it is, in their opinion, avoidable or unavoidable, useful or useless, deserved or undeserved. All sentient beings suffer during their lives, in diverse manners, and often dramatically.”

There already has been research into suggestions of the nature of the awareness which might be present in a patient who is in a permanent vegetative state. A brief article which describes and references some of the research can be found in the September 2008 issue of the American Journal of Bioethics/AJOB Neuroscience “Suffering and the Unconscious—The Harder Problem” by James D. Duffy (page 29). There is evidence that these patients may be aware in a momentary sense of a “pain” or some sensation, however they may not actually correlate it with memories such that the stimulus actually produces “suffering”. Much more research with the current modern tools of neuroscience is necessary.

All persons, whether alive or dead deserve dignity. All patients whether conscious or unconscious deserve dignity. But the question is how is the dignity expressed. In the case of Eluana Englaro or as in the case of Terri Schiavo is the dignity expressed by continuing a life prolonging treatment that went against the patient's previous known wishes or is it actually to preserve the dignity of a family, if present or a Pope, President, Premier or the assumed dignity of society? What is your answer? ..Maurice.

Graphic: Classic art from The Lion and Cardinal web site.