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Is it better to be minimally conscious than vegetative?
  1. Dominic Wilkinson1,2,
  2. Julian Savulescu2
  1. 1The Robinson Institute, Women's and Children's Hospital, University of Adelaide, North Adelaide, South Australia, Australia
  2. 2The Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
  1. Correspondence to Dr Dominic Wilkinson, The Robinson Institute, University of Adelaide, 72 King William Road, North Adelaide, South Australia 5006, Australia; dominic.wilkinson{at}

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In the case of Re M, summarised in the paper by Julian Sheather, Justice Baker faced the difficult task of weighing up objectively whether or not it was in M’s best interests to withdraw artificial feeding and to let her die.1 The judge concluded that M was ”recognisably alive”, and that the advantages of continued life outweighed the disadvantages. He compared her minimally conscious state (MCS) favourably to that of a persistent vegetative state (PVS).2 It was clear that artificial feeding would have been withdrawn if she had been in a PVS (her family and physicians had thought for some time that she was in this condition), but because she was in fact minimally conscious, the judge decided that treatment must continue. But does it make sense to treat MCS differently from PVS in this way? Is it better to be minimally conscious than unconscious? Similar questions have been raised before.3 In 2006, scientists reported results of sophisticated neuroimaging studies which suggested that some patients in persistent vegetative state (PVS), long thought to be unaware, had evidence of minimal consciousness.4 The question then was on the moral significance of this level of consciousness, and whether the presence of such evidence meant that treatment such as artificial nutrition must be continued.5 ,6

There are several potential reasons why the presence of minimal consciousness might warrant continuing life-sustaining treatment. The first is that patients in minimally conscious state (MCS) might have a better prognosis than those who are in PVS. There are relatively few studies …

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  • Contributors Draft prepared by DW and JS providing substantive comments and redrafts. Both authors approve the final draft.

  • Funding DW was supported for this work by an early career fellowship from the Australian National Health and Medical Research Council [1016641].

  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.

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