Patrick Forcier

H220

Pulling the Plug on Comas

Late in the month of February, 1990, while within the premises of her own home, Terri Schiavo
experienced a dangerous episode of cardiac arrest. This episode left her brain without a supply of
oxygen for some time, resulting in massive brain damage and death of neural tissue. Unfortunately, this
brain damage resulted in Terri Schiavo entering into a coma. She remained in this coma for over two
months before it was deemed that she was rather in a persistent vegetative state. Having no written
final directions for desired course of action, Schiavo remained in this condition for around fifteen years
before her husband was able to obtain a court order to remove the feeding and hydration tube which
was the key to her survival ultimately leading to her death. During those fifteen years, many legal
debates and trials occurred debating issues such as whether her husband should rightfully be the one to
make the final decision and especially whether the feeding tube should be removed. The Terri Schiavo
case in particular provides an insight as to how much controversy there truly is over the treatment of
coma patients or those patients that are unable to voice their final directives and do not have any
written declarations. This naturally raises the question of whether it is ethical to end a comatose
patient’s life if they have no final directive for treatment, assuming that the lawful successor is making
the decision. After considering the severity of the case, allocation of resources, and quality of life, it can
be found to be ethical to end the life of a comatose patient who has no final directives. Essentially, the
necessity of resources, and the desire for quality of life outweigh the value of the life of the patient.
The severity of the brain damage and thus the severity of the coma or state of being for the
patient is a primary issue to address when considering the likelihood of survival for the individual. A
patient with a Glasgow Coma Scale score of anywhere from a three to an eight is deemed to have severe
brain injury and ultimately be in a coma. At the point of fully being in a coma the likelihood of the
patient to survive or to ever be able to fully recover and function on their own is able to be heavily
questioned. For patients with a score of three to four, there is an 87% chance that they will die or will
remain in a non-responsive state for the rest of their life. And for patients with a score of anywhere
from five to seven there is still a 53% chance that they will die from their condition, while there is only
about a 30% chance that they will make any sort of decent recovery. This information goes to prove that
it is very unlikely for a patient to ever recover from a coma, and even if they were to do so, they would
retain damage to the brain which would affect their ability to function as a member of society for the
rest of their life. Because of this irreversible damage and being more likely to die than to survive, it is
ethical to end the life of a comatose patient with a Glasgow Coma Scale score of eight or below. The
allocation of resources within hospitals, and hospice care centers is a common issue to be presented to
those in charge of the care of the individuals in these centers. Commonly, patients will stay in hospitals
for a short while such as a couple of weeks while they undergo treatment. However, in terms of a coma
patient, a true deep coma can last easily four weeks and even if a patient recovers from that state, they
may be in a persistent vegetative state, or minimally conscious state for many years afterwards. Patients
in such a condition can require extensive care such as feeding and hydration tubes being in place, or
there is also the potential need for aided breathing in comatose patients. Then there needs to be a bed
for the individual. All of which take up resources from the medical center, meaning that there is another
individual who may require some of the same treatment, but has a very likely chance of survival if they
receive these resources, that is unable to get this care because these resources have been dedicated to
a comatose patient. Furthermore, every moment that a doctor spends assessing the condition of a
comatose patient, or saving their life if something goes wrong, is time that is not spent with patients
that have a much higher chance of survival. This means that comatose patients who have a very low
chance of recovery are using resources that are in fact limited that would serve to nearly guarantee life
to another patient, and because these resources are limited they should be dedicated to those with a
greater chance of survival. So, because of these reasons, it is again ethical to terminate the life of a
Patrick Forcier
H220

comatose patient. Quality of life is a very interesting concept when dealing with comatose patients. And
when I use it as a way for individuals to be able to ethically terminate the life of an individual in a coma, I
mean quality of life for the family, friends, and other successors of the individual simply because there is
no measure of how the individual is feeling or what they are thinking so there is no way to define quality
of what life they have. One aspect is the cost that must be assessed for continuing with the life of the
patient. For example, if the patient is in hospice care due to low chance of survival, the average price
paid out for hospice care is one hundred and fifty dollars which equivalates to over 4,000 a month. On
the other hand, an Intensive Care Unit can cost thousands for just a couple days or weeks there. While
Medicare and other insurances help cover the cost, they do not always cover it all which can place a very
large financial burden on a family trying to keep a comatose patient alive. This can lead to them going
into debt and even further result in future decrease in quality of life for them. Furthermore, there are an
immeasurable amount of emotional burdens placed on those caring for a loved one in a coma. This in
turn leads to depression and potentially other psychological damages that can lead to further
complications. And so, it is clear that the quality of life of the successors of the comatose patient, can
decrease quite significantly. These all go to show that there are plenty of perfectly ethical considerations
for terminating the life of a comatose patient.
While the reasons aforementioned outweigh the life of the comatose individual, there are
counterarguments that can be made. Rising above other counterarguments is that it is sometimes
impossible to prove what the patient would have wanted in this case and so they should be kept alive to
find out the answer (considering that this is about patients with no final directives). And this is
absolutely true that there is no way to know, however, there are already laws in place that strike down
this counterargument because these laws appoint a successor of the individual to make the decision. For
example, a spouse would be appointed to act in the best wishes of what they think the other would
want. Thus, the argument that they should be kept alive to try to find out is irrelevant. Another
argument to be made is that the comatose individual has a right to life. That they have a right for the
doctors to do what it takes to keep them alive if there is no other directive. And yes, they do have a right
to life, yet so do all of the other patients in the hospital. So how can one care be prioritized over saving
countless other lives? Every moment the doctor spends taking care of a comatose patient is a moment
they are not taking care of other patients who deserve their right to life yet have a much better chance
of surviving and living a functional life. Additionally, it is a rule of thumb in allocation of resources to
treat those that have the greatest chance of survival. While it is also true that those who need it most
should be treated, the good of many others is above the good of one. Lastly, there is the argument of
cases such as Terry Wallis who came out of a coma after 19 years so how can one terminate a life when
there is always this chance? However, defeating this argument is the fact that every case is different and
all can be affected differently which is what may have allowed him to come out of the coma after such a
time. The odds of it being a regular occurrence and being a functional member in society again is nearly
none.
While it has always been clear to see that there is immense controversy over the care of
comatose individuals, it can now be seen that the ethical decision is ultimately to end the life of the
patient. This is assuming that there is little to no chance of recovery (being an 8 or below on the
Glasgow Coma Scale) and that there is no final directive written by the individual. It is a tragic idea to
have to end the life of someone, however, the good that comes of it outweighs the good of keeping
them alive in that state. Due to this ethic, more people will be able to be treated and saved through the
allocation of resources to those who have a greater chance of survival, and the quality of life of those
succeeding the individual will be enhanced. Both of which outweigh the life or lack thereof, the
comatose individual.
Patrick Forcier
H220

Works Cited
“Brain Injury - Coma: Some Facts.” Braininjury.Com | Coma: Some Facts,
www.braininjury.com/coma.shtml.

“Medical Aspects of the Persistent Vegetative State — NEJM.” New England Journal of Medicine,
www.nejm.org/doi/full/10.1056/NEJM199406023302206#t=article.

“The Glasgow Structured Approach to Assessment of the Glasgow Coma Scale.” Glasgow Coma Scale,
www.glasgowcomascale.org/.

Hamel, M B, et al. “Cost effectiveness of aggressive care for patients with nontraumatic coma.” Critical
care medicine., U.S. National Library of Medicine, June 2002,
www.ncbi.nlm.nih.gov/pubmed/12072667.

Writer, Author Bill Fay Staff. “Hospice and End-of-Life Options and Costs.” Debt.org,
www.debt.org/medical/hospice-costs/.