Post-Comatose Disorders of Consciousnesscapacities that Levy and Savulescu take to be required for full moral status. In other words, Levy
and Savulescu’s account of full moral status has radically counter-intuitive consequences.
Levy and Savulescu might respond to this challenge in one of two ways. On the one hand,
they could bite the bullet, and hold that our current practice of affording full moral status to
neonates, amnesiacs, and those suffering from advanced dementia is mistaken. Although this
response will have its advocates, we see little prospect of it finding broad favor within the
healthcare and bioethics communities, for we do treat these patient groups as though they have
full moral status, regardless of the deficiencies they might have in particular cognitive capacities.
An alternative—and to our mind more plausible—response would be to modify their
account of full moral status so as to ensure that neonates, amnesiacs, and those suffering from
advanced dementia possess full moral status despite their defects. Here one might argue that an
account of a creature’s moral status must be informed not only by information about its cogni-
tive capacities, but also by information about the social relationships in which it is embedded. If
an account of full moral status is modified in this way, then post-comatose patients might indeed
qualify as possessing full moral status. After all, brain-damaged patients once enjoyed complex
forms of self-consciousness, and they are the natural objects of moral care and concern from
families and community-members in the way that neonates, amnesiacs, and those suffering from
severe dementia are.
In addition to wrestling with questions of moral status, the bioethics literature has also wres-
tled with questions relating to quality-of-life in post-comatose patients. What kind of subjective
life do such patients have, and is it a life that is in any sense worth living?
Kahane and Savulescu (2009) argue that there is good reason to think that such patients are
unlikely to have a life worth living, and thus that it might be in the interests of such patients for
their life to be terminated. In support of this position, they note that a number of studies have
indicated that the majority of people would prefer not to be given life-sustaining treatment
if they were in a non-reversible VS (Frankl et al. 1989; Emmanuel et al. 1991). They go on to
suggest that this preference might reflect “recognition of an objective interest in not continuing
to exist in a state that has no personal meaning and that could be seen as degrading to one’s
dignity as a rational being” (Kahane and Savulescu 2009: 15). We are not persuaded that the
results of these studies have much relevance for questions about the moral significance of covert
consciousness in post-comatose patients, for the individuals who participated in these studies
presumably understood by “the vegetative state” a state of complete unconsciousness.
Of more direct relevance to the current discussion are studies of quality-of-life in locked-in
syndrome patients, which suggest that such patients enjoy surprisingly high levels of subjec-
tive well-being (Bruno et al. 2011a; Lulé et al. 2009; Nizzi et al. 2012). On the basis of these
studies, one might be tempted to draw conclusions about subjective well-being in covertly
conscious VS patients. However, Kahane and Savulescu point out that there are important dif-
ferences between the locked-in syndrome patients that are surveyed in these studies and covertly
conscious VS patients. The former are capable of some form of communication and agency,
whereas the latter (typically) have no capacity for communication or external agency. Kahane
and Savulescu conclude that it is far from obvious that the lives of covertly conscious VS patients
are worth living, and suggest that their condition is “far worse than that of someone in the worst
form of solitary confinement.” Terminating the life of such individuals, they suggest, might not
be merely permissible but morally required.
Kahane and Savulescu are right to point out the potential problems in generalizing from
claims about the subjective well-being in (partially) locked-in patients to that of covertly con-
scious VS patients. However, we are not convinced that the quality-of-life that they imagine
covertly conscious VS patients might have would be as bleak as they suggest. Although such