Deontological and utilitarian ethics: a brief introduction in the context of disorders of consciousness

Abstract

Purpose: The aims of this paper are to discuss three different ethical frameworks; to briefly consider some of the philosophical positions concerning the nature of personhood. Clear consideration of these issues demonstrates the complexity of decision making in persisting disorders of consciousness. Method: Three different ethical frameworks, Kantian deontology, act utilitarianism and rule utilitarianism, are described and three different accounts of personhood are presented and analysed. Results: These result in very different approaches to the management of patients in permanent vegetative states (PVSs), making it possible to argue for withdrawal of clinically assisted nutrition and hydration in all cases, considering the issues on a case by case basis or continuing to treat all patients whatever their wishes. Conclusions: These results explain why doctors often have different views on how to treat patients in PVS, particularly with regard to the withdrawal of clinically assisted nutrition and hydration. Understanding such issues may help clinicians articulate more clearly the reasons for their intuitions surrounding the management of patients in PVSs.

Implications for Rehabilitation

• Patients with persisting disorders of consciousness pose significant dilemmas for clinicians and family members.

• Utilitarianism is a consequentialist theory, that is, it is concerned with the outcome of our actions to determine their morality. It is the concept that the right action is the one that will result in “the greatest amount of good for the greatest number”.

• Deontological ethics suggests that there are certain sorts of acts that are wrong in themselves independent of the result of such actions.

• Personhood can be approached from a variety of perspectives including biological, relational, religious and psychological.

• Understanding different ethical frameworks, and the nature of personhood, may help clinicians articulate more clearly the reasons for their intuitions.

• Deontology
• ethics
• persisting disorders of consciousness
• personhood
• utilitarianism

Declaration of interest

The authors report no conflicts of interest.

E. D. P. was supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre.