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S. Holland, Treatment decision, death and the value of life, QJM: An International Journal of Medicine, Volume 110, Issue 3, March 2017, Pages 121–123, https://doi.org/10.1093/qjmed/hcw182
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Introduction
The ontological status of patients—i.e. whether they are alive or dead—doesn’t usually influence treatment decisions. That most patients are alive is self-evident and irrelevant, and treatment decisions are no longer required for the clearly deceased. But the appropriate treatment of a minority of troubling patients turns on their ontological status. For example, that a brain dead patient artificially maintained on life-support is legally dead permits the retrieval of transplant organs.
Treatment should be based on ontological status only if two questions can be compellingly answered: first, is the patient alive or dead; and second, if the patient is alive, what is the value of their life? But both questions are notoriously controversial. The first requires a definition of death whilst the latter requires ascertaining what makes life valuable. This review article clarifies why the prospects of answering each question remain poor.
What is death?
It is well established that the definition of death—and the criteria and tests to determine whether death, thus defined, has occurred—is controversial (Youngner et al. 1999).1 Less obvious is the root cause of the problem, which is that our ordinary concept of death is too complex to be reduced to one simple definition. This will be illustrated by considering patients in the Permanent Vegetative State (PermVS).
