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Mind Perception and Willingness to Withdraw Life Support

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Abstract

Discussions of withdrawal of life support often revolve around a patient’s perceived level of suffering or lack of experience. Personhood, however, is often linked to personal agency (e.g., self-control, ability to plan). In the present study, 279 laypeople estimated the amount of agency and experience in hypothetical patients differing in degree of consciousness. Participants also indicated whether they would choose to maintain or terminate life support. Patients were more likely to terminate life support for a patient in a persistent vegetative state (PVS), followed by one with amyotrophic lateral sclerosis (ALS) and in a minimally conscious state (MCS). The decision to maintain life support was reliably predicted by perceptions of a patient’s agency but life support decisions were not significantly predicted by ratings of experience. In sum, decisions regarding maintaining life support are more influenced by perceptions of a patient’s ability to plan and act than by perceptions of a patient’s ability to feel or experience.

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Notes

  1. While these variable were found to differ significantly across conditions, and frequently predicted decisions to withdraw life support, they fall outside the primary focus on this paper. With the exception of the manipulationc check, they will be discussed in a future paper.

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Author information

Authors and Affiliations

  1. Department of Psychology, Muhlenberg College, 2400 Chew Street, Allentown, PA, 18104, USA

    Jeffrey M. Rudski

  2. Department of Neuroscience, Muhlenberg College, 2400 Chew Street, Allentown, PA, 18104, USA

    Benjamin Herbsman & Eric D. Quitter

  3. Department of Biochemistry, Muhlenberg College, 2400 Chew Street, Allentown, PA, 18104, USA

    Nicole Bilgram

Authors
  1. Jeffrey M. Rudski
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  2. Benjamin Herbsman
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  3. Eric D. Quitter
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  4. Nicole Bilgram
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Corresponding author

Correspondence to Jeffrey M. Rudski.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflicts of Interest

The authors have no conflicts of interest to report.

Funding

This project was self-funded as part of an undergraduate research seminar on neuroethics.

Appendix

Appendix

ALS Condition

The patient is completely immobile. A feeding tube was inserted after the patient lost the ability to swallow, and they became entirely dependent on hospital staff for life support. Communication with doctors and family members was made nearly impossible as a result of paralysis of the patient’s voluntary muscles. As a result of the medical equipment, the patient’s sleeping also became disturbed and restless. EEG and PET scans, performed after the patient had been in this condition for twelve months, indicated that there was normal brain activity in the regions associated with consciousness, personality, and emotion. The patient has been in this stable condition for a period of twelve months.

MCS Condition

Following a car accident, the patient was admitted to a hospital due to an accident-induced coma. The patient’s spinal cord was not affected during the accident. Despite this, they were left bedridden and immobile. They are incapable of breathing or eating on their own, and were placed on a ventilator and a feeding tube. A series of specialized visual and motor assessments demonstrated that the patient’s basic reflexes are not intact. Further tests suggested that the patient is incapable of feeling or hearing loved ones nearby. EEG and PET scans, performed after the patient had been comatose for twelve months, indicated that there was some brain activity in the regions associated with consciousness, personality, and emotion. Therefore, it is possible that the patient has some level of consciousness. The patient’s awareness, as well as their capability of feeling emotions is difficult to determine. The patient has been in this stable condition for a period of twelve months.

PVS Condition

Following a car accident, the patient was admitted to a hospital with an apparent coma-like state. The patient’s spinal cord was not affected during the accident. They were left bedridden and immobile. They were incapable of breathing or eating on their own, and were placed on a ventilator and a feeding tube. A series of specialized visual and motor assessments demonstrated that the patient’s basic reflexes are not intact. Further tests suggested that the patient is incapable of feeling or hearing loved ones nearby. After performing EEG and PET scans to determine the patient’s brain function, it was determined that the patient suffered from extensive brain damage. These tests indicated that there was a complete lack of brain activity in the regions associated with personality, consciousness, and emotion. The patient has been in this stable condition for a period of twelve months.

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Rudski, J.M., Herbsman, B., Quitter, E.D. et al. Mind Perception and Willingness to Withdraw Life Support. Neuroethics 9, 235–242 (2016). https://doi.org/10.1007/s12152-016-9269-4

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  • DOI: https://doi.org/10.1007/s12152-016-9269-4

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