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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
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.
Perry, David. 2001. Ethics and Personhood: Some Issues in Contemporary Neurological Science and Technology. Santa Clara University. Retrieved from http://www.scu.edu/ethics/publications/submitted/Perry/personhood.html. Accessed January 9, 2016.
World Health Organization. 2013. The top 10 causes of death. www.who.int/mediacentre/factsheets/fs310/en/. Accessed January 9, 2016.
Farah, Martha J. 2013. Personhood, consciousness, and severe brain damage. In Neuroethics in Practice: Medicine, Mind and Society, eds. Annan Chatterjee, and Martha Farah, 175–186. New York: Oxford University Press.
Wilson, Samuel, and Nick Haslam. 2012. Reasoning about human enhancement: towards a folk psychological model of human nature and human identity. In Handbook of research on Technoself, ed. Rocci Luppicini, 175–188. Hershey, PA: IGI Global.
Schick, Theodore Jr., and Lewis Vaughn. 2012. The definition of death. In Doing Philosophy: An Introduction Through Thought Experiments, 5 edn. New York: McGraw-Hill.
Bernat, James L. 2006. The whole-brain concept of death remains optimum public policy. The Journal of Law, Medicine & Ethics 34: 35–43.
Veatch, Robert. 1993. The impending collapse of the whole-brain definition of death. Hastings Center Report 23: 18–24.
McMahan, Jeff. 1998. Brain death, cortical death, and persistent vegetative state. In A companion to bioethics, eds. Helga Kuhse, and Peter Singer, 250–260. Oxford: Blackwell.
Shewmon, D. Alan. 2009. Brain death: can it be resuscitated? Hastings Center Report 39: 18–24.
Bernat, James L. 2014. There can be agreement as to what constitutes human death. In Contemporary debates in bioethics, eds. Arthur L. Caplan, and Robert Arp, 377–387. Malden, MA: John Wiley & Sons.
Nicholas, Epley, and Adam Waytz. 2009. Mind perception. In The handbook of social psychology, 5th edn, eds. Susan T. Fiske, Daniel T. Gilbert, and Gardner Lindzey, 498–541. New York: Wiley.
Gray, Heather M., Kurt Gray, and Daniel M. Wegner. 2007. Dimensions of mind perception. Science 315: 619.
Demertzi, A., et al. 2011. Attitudes towards end-of-life issues in disorders of consciousness: a European survey. Journal of Neurology 258(6): 1058–1065.
Hodges, Marion O., Susan W. Tolle, Carol Stocking, and Christine K. Cassel. 1994. Tube feeding. Internists’ attitudes regarding ethical obligations. Archives of Internal Medicine 154: 1013–1020.
Payne, Kirk, Robert M. Taylor, Carol Stocking, and Greg A. Sachs. 1996. Physicians’ attitudes about the care of patients in the persistent vegetative state: a national survey. Annals of Internal Medicine 125: 104–110.
Gipson, Jacob, Guy Kahane, and Julian Savulescu. 2014. Attitudes of lay people to withdrawal of treatment in brain damaged patients. Neuroethics 7: 1–9.
Haslam, Nick, Brock Bastian, Simon Laham, and Stephen Loughnan. 2012. Humanness, dehumanization, and moral psychology. In The Social Psychology of Morality: Exploring the Causes of Good and Evil, eds. Mario Mikulincer, and Phillip R. Shaver, 203–218. Washington, DC: American Psychological Association.
Kant, Immanuel. 1785/1998. Groundwork of the metaphysics of morals, ed. Mary Gregor. Cambridge: Cambridge University Press.
Waytz, Adam, Kurt Gray, Nicholas Epley, and Daniel M. Wegner. 2010. Causes and consequences of mind perception. Trends in Cognitive Sciences 14: 383–388.
Judt, Tony. 2010. Night. The New York Review of Books. Downloaded from http://www.nybooks.com/articles/2010/01/14/night/. June 10, 2016.
Wegner, Daniel M., and Kurt Gray. 2016. The Mind Club. New York: Viking.
Kahane, Guy, and Julian Savulescu. 2009. Brain damage and the moral significance of consciousness. Journal of Medicine and Philosophy 34: 6–26.
Laureys, Steven. 2005. Death unconsciousness and the brain. Nature Reviews Neuroscience 6: 899–909.
Brickman, Philip, and Dan Coates. 1978. Lottery winners and accident victims: is happiness relative? Journal of Personality and Social Psychology 36: 917–927.
Glannon, Walter. 2013. Prognosis matters, not diagnosis. American Journal of Bioethics Neuroscience 4: 34–35.
Katja Kuehlmeyer, Nicole Palmour, Richard J. Riopelle, James L. Bernat, Ralf J. Jox, and Eric Racine. 2014. Physicians’ attitudes toward medical and ethical challenges for patients in the vegetative state: comparing Canadian and German perspectives in a vignette survey. BMC Neurology, 14:119 http://bmcneurol.biomedcentral.com/articles/10.1186/1471-2377-14-119. Accessed January 8, 2016.
Johnson, Kimberly S., I. Katja, and James A. Tulsky. 2005. The influence of spiritual beliefs and practices on the treatment preferences of African Americans: a review of the literature. Journal of the American Geriatrics Society 53: 711–719.
Wijdicks, Telco F. 2001. The diagnosis of brain death. New England Journal of Medicine 344: 1215–1221.
Ojalehto, Bethany, Douglas L. Medin, and Garcia G. Salino. 2015. Agency concepts across cultures: how intuitive is folkpsychology? In Proceedings of the 37th annual meeting of the cognitive science society, eds. David C. Noelle, Rick Dale, Anne S. Warlaumont, Jeff Yoshimi, Teenie Matlock, Carolyn D. Jennings, and Paul Maglio, 1763–1768. Austin, TX: Cognitive Science Society.
Gomes, Anil, Matthew Parrott, and Joshua Shepherd. 2015. More dead than dead? Attributing Mentality to Vegetative State Patients. Philosophical Psychology: 1–12. doi:10.1080/09515089.2015.1048328.
Paolacci, Gabriele, and Jesse Chandler. 2014. Inside the turk: understanding mechanical turk as a participant pool. Current Directions in Psychological Science 23: 184–188.
Pew Research Center. 2013. Views on End-of-Life Medical Treatments. http://www.pewforum.org/2013/11/21/views-on-end-of-life-medical-treatments/. Accessed January 9, 2016.
Samuelson, William, and Richard Zeckhauser. 1988. Status quo bias in decision making. Journal of Risk and Uncertainty 1: 7–59.
Johnstone, Megan-Jane. 2013. Alzheimer’s Disease, Media Representations and the Politics of Euthanasia. Burlington VT: Ashgate Publishing.
Truog, Robert D. 2008. End-of-life decision-making in the United States. European Journal of Anesthesiology 25(Suppl 42): 43–50.
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.
This project was self-funded as part of an undergraduate research seminar on neuroethics.
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.
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.
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.
Rights and permissions
About this article
Cite this article
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
- Mind perception
- Withdrawal of treatment
- Minimally conscious state
- Persistent vegetative state
- Amyotrophic lateral sclerosis