September 27, 2022


What should be done with patients deemed to be in a "permanent vegetative state"? A discussion in the current Journal of Medical Ethics shows that there is a growing interest in using their bodies for medical experiments. They would be especially useful in studying the long-term effects of transplanting animal organs. The patients often survive for years, and if a virus affected their brains or other vital organs, very little harm would be done.

Some bioethicists have even contended that PVS patients are actually dead and can be treated as cadavers. But Dr Steven Curry, of the University of Melbourne, disagrees, partly because they aren’t dead and partly because it would be too difficult to persuade the public that they are.

PVS patients are alive, he contends, but they have nothing to lose and they can contribute to the common good:

"Those who are in a PVS will not ever wake up, they feel no pain or discomfort and have no continuing interest in their own survival… these patients must also have a right to risk that life for the common good… The patients will not be able to have children and have no capacity for movement, so that their possible confinement does not violate the interest that underpins the right to free movement… Also, no risk of withdrawal of consent exists."

Ideally, of course, people should agree in advance to such experiments by enrolling in a register. But it is unlikely that many people will, as few people anticipate living in a comatose state for several years. Hence, says Dr Curry, it ought to be possible to get others to consent on their behalf "with reference to the person’s values and stated preferences".

Australian bioethicist Peter Singer has a reputation of supporting nearly any form of technological progress, no matter how much it may conflict with traditional ethical values. But his critics may be interested to know that he does not give an unqualified Yes to everything.

In a recent article in the Guardian, Singer expresses his misgivings about the growing practice of genetic selection of children. This has become more widespread with the expansion of the range and quality of genetic tests. Is this eugenics? asks Singer. Yes, it is, but in liberal, market-driven societies, it will not be the totalitarian eugenics of the past. There is nothing essentially wrong with it. Still, he says, it offers “perils as well as blessings”.

The perils have nothing to do with destroying embryos or foetuses, but with social inequity. Parents who select their chidden on the basis of sex desire the best for their child, but all children will be worse off, because of an increasingly distorted sex ratio, as in China and India. And, warns Singer, widespread demand for selecting children with a superior genetic make-up could be dangerous as well.

“Since above-average height correlates with above-average income, and there is clearly a genetic component to height, it is not fanciful to imagine couples choosing to have taller children. The outcome could be a genetic ‘arms race’ that leads to taller and taller children, with significant environmental costs in the additional consumption required to fuel larger human beings.

“The most alarming implication of this mode of genetic selection, however, is that only the rich will be able to afford it. The gap between rich and poor, already a challenge to our ideas of social justice, will become a chasm that mere equality of opportunity will be powerless to bridge. That is not a future that any of us should approve.”

What is to be done? Singer is unsure. Banning genetic selection, in his eyes, smacks of totalitarian coercion. Permitting it will require enormously expensive subsidies to poor parents.