Andrew Peterson and Tim Baynelikely to have the capacity to experience pleasurable bodily sensations and perceptual states; they
are likely to also have the capacity to experience unpleasant bodily sensations and perceptual states.
We should therefore treat patients who are likely to be conscious with care and consideration,
attempting to both minimize their chances of having aversive experiences and maximize their
chances of having meaningful and positive experiences (Graham et al. 2015). If we remain uncer-
tain about the presence of consciousness in certain patients, it is ethically prudent to treat them as
if they were conscious (Peterson et al. 2015). Doing so avoids the various ethical hazards that might
arise if we are mistaken about a patient’s purported unconsciousness.
The more controversial question is whether the (mere) presence of consciousness implies
that patients have what many authors refer to as “full moral status.” A creature has full moral
status if and only if it has a right to life. If post-comatose patients have full moral status, then we
have an obligation not merely to prevent them from suffering, but also to ensure that they are
not subject to premature death.
A number of prominent bioethicists have argued that even covertly conscious post-comatose
patients lack full moral status. Levy and Savulescu (2009) write:
A being acquires a full moral status, including the right to life, if its life matters to it;
that is, if it is not only momentary experiences that matter—as for the being capable
only of phenomenal consciousness—but also an ongoing series of experiences. A full
right to life requires that it is not only experiences that matter to one, but also how
one’s life actually goes; that is, that satisfaction of one’s interests matter to one, and this
requires very sophisticated cognitive abilities, such as an ability to conceive of oneself
as a being persisting through time, to recall one’s past, to plan, and to have preferences
for how one’s life goes.
(Levy and Savulescu 2009: 367; see also Davies and
Levy 2016; Kahane and Savulescu 2009)On this view, post-comatose patients have the kind of moral status that is often attributed to
many non-human animals: although we ought to take their welfare into account in our deci-
sion-making, they lack a right to life, and we need little justification for (painlessly) ending their
life. What should we make of this position?
We agree with Levy and Savulescu that the fMRI and EEG data surveyed in this chapter
provide little reason to think that post-comatose patients possess the cognitive capacities that
they take to be required for full moral status. For example, the fact that a patient might be able
to follow commands does not give us reason to think that he or she conceives of him- or herself
as a being that persists through time. The ability to correctly answer autobiographical questions
arguably provides the strongest evidence for the kind of cognitive capacities that Levy and
Savulescu require for full moral status, but even here it is unclear whether this ability involves
episodic memory (and thus speaks to the question of moral status) or whether it involves only
semantic memory (and thus does not speak to this issue). Indeed, even patients who have
emerged from the MCS and are able to communicate may be unable to “recall their past, plan,
or have preferences for how their life goes.”
However, these considerations show that post-comatose patients lack full moral status only if
Levy and Savulescu’s account of full moral status is defensible. A full-scale examination of that
issue goes well beyond the scope of this chapter, but we do want to draw attention to some of the
central challenges facing their account. Most fundamentally, it is at odds with current conceptions
of the scope of full moral status, for we routinely afford full moral status to individuals—such
as neonates, amnesiacs, and those suffering from advanced dementia—who lack the cognitive