Abstract

We can all appreciate the particular quality of the searing pain of touching a hot stove or the mouth-watering aroma of freshly-baked cookies. The capacity to experience these and other sensations, to react to them, and possibly to report on them is part of what it is to be conscious beings, beings for which it is like something to be. Against the background of normal states of consciousness, we can identify disorders of consciousness, perturbations of this awareness of self and environment that affect people as a consequence of traumatic and non-traumatic brain injury. A variety of global disorders of consciousness have been identified, including coma, persistent vegetative state (PVS), and minimally conscious state (MCS). Estimating the numbers of patients affected by these disorders is difficult, both because of difficulties in delineating and diagnosing them, and because of a lack of a formal reporting structure. However, a 2005 estimate of patients in PVS in the US ranged from 40–168 per million (Beaumont and Kenealy 2005), while another earlier estimate for PVS in the US was 14,000–35,000 (The Multi-Society Task Force on PVS, 1994). MCS prevalence was estimated to be between 45,000 and 250,000 (Fins et al. 2008). Regardless of exact numbers, it is clear that disorders of consciousness affect a great many people, few of whom are likely to regain normal consciousness. This chapter addresses the ethical issues raised by these cases.