Withdrawing Life Support: Only One Person’s View Matters

Dominic Wilkinson, University of Oxford

Shortly before Frenchman Vincent Lambert’s life support was due to be removed, doctors at Sebastopol Hospital in Reims, France, were ordered to stop. An appeal court ruled that life support must continue.

Lambert was seriously injured in a motorcycle accident in 2008 and has been diagnosed as being in a persistent vegetative state. Since 2014, his case has been heard many times in French and European courts.

His wife, who is his legal guardian, wishes artificial nutrition and hydration to be stopped and Vincent to be allowed to die. His parents are opposed to this. On Monday, May 20, the parents succeeded in a last-minute legal appeal to stop Vincent’s doctors from withdrawing feeding, pending a review by a UN Committee on the Rights of Persons with Disabilities.

Lambert’s case is the latest example of disputed treatment for adult patients with profound brain injury. The case has obvious parallels with that of Terri Schiavo, in the US who died in 2005 following seven years of legal battles. And there have been other similar high-profile cases over more than 40 years, including Elena Englaro (Italy, court cases 1999-2008), Tony Bland (UK 1993) Nancy Cruzan (US 1988-90) and Karen Ann Quinlan (US 1975-76).

Contrasting responses

There are two contrasting responses to cases like that of Lambert. Some people read about his case and react with horror at the idea of being kept alive against their will in a state where they are completely dependent, unaware of their surroundings and with no apparent prospect of ever recovering.

Other people respond with horror at the idea of stopping feeding and allowing a profoundly disabled man to die, when he does not appear to be suffering and could be sustained in his current condition for months or years.

There are also contrasting ethical arguments. Some people point to the lack of benefit for Vincent in continued life. Because he has no conscious interests, it is not in his best interests to keep him alive, the argument goes. Others contend that his essential human dignity remains despite his profound disability and that his life must be protected “until its natural end”.

The UN Committee for the Rights of Persons with Disabilities might have concern for the rights of the severely disabled to receive life-prolonging medical treatment. But there is a potentially competing right for disabled persons not to receive treatments they would not have wanted and not to have their lives prolonged in states they would have regarded as deeply undesirable.

It can be useful to debate such questions, but the long history of similar cases points to the ongoing challenge of reaching a common view on these issues. Quite simply, we will never all agree on what should happen in such cases. There are opposing reasonable ethical views. The important question is: what should we do in the face of such intractable disagreement?

Our societies are increasingly diverse; we have to accept that people have a range of different values and we should tolerate those differences. That acceptance and tolerance mean that we should allow people to live their lives based on their own ethical views and values, as long as they don’t harm others. It is perfectly acceptable for people to express their views about situations, such as that of Vincent Lambert. But it is not acceptable to impose other people’s views on Lambert’s life.

The only defensible ethical response to reasonable disagreement in cases like that of Vincent Lambert is to make decisions based on his values and wishes. If, as is claimed by Vincent’s wife, Vincent would not have wished to remain alive, then the wishes of his parents, of other doctors or of the Pope, are irrelevant. My views or your views on the matter, likewise, are of no consequence. Only Vincent’s wishes matter. And so life support must stop.The Conversation

Dominic Wilkinson, Consultant Neonatologist and Professor of Ethics, University of Oxford

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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6 Responses to Withdrawing Life Support: Only One Person’s View Matters

  • Anthony Drinkwater says:

    Thank you for this well-argued dose of common ethical sense!
    It is fortunate that the rarity of the similar examples that you cite demonstrates that this common sense is almost universal, outwith the vocal few who insist on imposing their own ideologies on others.

  • Marco Vergano says:

    Thank you for this concise argument “in favour of (medical) ethical dissensus”. I totally agree with your claim that “only one person’s view matters”.
    Neverheless, I would like to hear your opinion about the relevance of other persons’ interests in the event that the patient’s wishes are totally unknown (or not clear, or disputed).
    Would it be morally unacceptable to follow the wishes of the caregivers, since their loved one is no more capable of conscious experience and thus not a bearer of conscious interests?
    If there is nor suffering nor joy, the interest in continued life could be irrelevant as well as the interest in dying (in absence of advance directives), so the wishes of the family could become relevant.
    In my advance directives I stated that I would not wish to be cured in case of a catastrophic brain injury, but also that in the case of a permanent vegetative state, my wishes would become almost irrelevant, since it would mean the end of my biographical life (death by higher brain criteria), and my loved ones should make choices according to their own interests.

  • Richard Hain says:

    We need to be clear what we mean by views that ‘matter’.

    I too agree with the view that Dominic expresses; namely that if a person has made views about their own treatment clear, those views must be regarded as authoritative. Those cases are indeed rare, but there is a correlate with the issue of organ donation, where all too frequently the expressed wishes of an individual to donate organs are over-ridden in the name of sensitivity to the wishes of family.

    That is an argument for saying that an individual’s wishes, where clearly expressed, should carry more weight that anyone else’s – and often more than everyone else’s put together. But that is not the same as saying that others’ wishes ‘do not matter’. That would be an unrealistic representation of how people actually relate to one another. The dying of one person does impact on others, and it is quite legitimate for people who are affected by a decision to have and to express opinions on it. The views of relatives DO matter – even if doctors (correctly) decide to over-ride them.

    There is all the difference in the world between imagining that views do not matter, and recognising that they do matter and nevertheless recognising when they should be set aside.

  • Manuel Zunin says:

    In my opinion, from a bioethics point of view, we can’t support the end of life decisions of a person when he does not leave written instructions about his wishes. Any ethics statement on the matter should include the disagreements over his current state and what he would have wanted are at the heart of his family’s divisions. I can’t approve your point of view. I quote a statement I consider of relevant value about this case “French medical professionals said that Mr Lambert’s condition had been stable for ten years and that gauging his state of consciousness was too complex to reach an undoubted conclusion. To decide in the place of people who cannot express themselves, to judge that their life is not dignified or ‘has no meaning,’ is neither ethical nor scientifically justifiable, they wrote. (Le Monde, May. 20, 2019)”

  • Richard Hain says:

    Hi, Manuel,

    I wasn’t sure whether you were disagreeing with me or with Dominic 🙂

    I would see the concept of dignity (and, to a certain extent, of meaning) as an articulation of the point I was trying to make. The idea behind dignity is that there is something about a person that is important and valuable beyond what can be explained by what the individual herself experiences. Dignity is the idea that a dead body should be treated with respect, not because the dead body benefits from that respect, but because respecting dead bodies benefits those who are living (including the person doing the respecting). Dignity is a relational concept because it expresses something about how individuals live in community with one another, rather than being a structural characteristic of a single individual (like a capacity for formal reasoning, for example).

    Many life-sustaining interventions are profoundly undignified, and it seems reasonable to me to conclude that they are sometimes wrong, and should be stopped, for that reason. Interventions that jeopardise dignity without offering any benefit are surely wrong.

  • Ian says:

    Discussing the importance of life as profoundly affected by dignity and meaning does form part of the issue, but as in many ethical debates it can easily become lost within its own horizons. In deed the modern paradox of life frequently ties various forms of quality to forms/levels of intelligent communication.

    If this discussion can be equated with a person trapped within circumstances which were not initially fully comprehended, unable to express any effective opinion, or themselves then alter their circumstances; Viktor Frankls’ – ‘Man’s Search for Meaning: An Introduction to Logotherapy’ could provide an informative perspective by highlighting how becoming lost in that sense affects people more generally.

    Because he approaches his points from a certain psychological perspective, many set within death camps, his writing illustrates this type of ‘caught within ones own horizons’, especially where those horizons are structured elsewhere. As expressed dignity was no real option in those circumstances, he largely reflects on the value of responsibility, freedom and meaning. The importance of life, no matter how bad, in his earlier observations becomes a fluid but critical element. He does, rather erroneously in my view, state later on that euthanasia is an acceptable option. But that statement appears to be distanced from much of the documented experiences in his book, and so bounded by other influences. Just as the focus of this thread has caused this response to be similarly bounded, missing much of the transcendent value within that book.

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