This shows that PLCC is perceived

as much more burdensome for those surrounding the patients and for society at large than it is for the patients themselves. So in examining the claim that PLCC patients should not be tortured by being kept alive with no hope of recovery, one should be very careful “to think whether we’re quite certain it’s the patient who’s being tortured or us.”12 It is important to acknowledge that we may sometimes have Inhibitors,research,lifescience,medical a problem with such patients’ presence; in Professor Meilaender’s words in relation to patients with advanced dementia, “there’s a part of us, there’s a part of me that inevitably wishes they’d go away not because it’s such a problem, but because they’re one of us. They show us our future, and they make us very uneasy.”12 Social attitudes towards loss of cognitive capacities and the perception of personhood Inhibitors,research,lifescience,medical Stephen Post suggests that “we live in a culture

that is … dominated by heightened expectations of rationalism and economic productivity, so clarity of mind and productivity inevitably influence our sense of the worth of a human life.”5 In such “hypercognitive culture”5 it is only natural that loss Inhibitors,research,lifescience,medical of cognitive capacities may be perceived as loss of personhood. Different approaches to personhood have implications for the definition of PLCC patients as “persons” or “non-persons.” Inhibitors,research,lifescience,medical For those who advocate that it is necessary to possess certain cognitive capacities to qualify as a

person, PLCC patients would not be BMS345541 regarded as such. Yet, they are definitely persons within the perception of inherent/ transcendental personhood, for which being a human is equated with being a person. According to interpersonal theories, their personhood depends on its recognition by others.21 The recognition of PLCC patients as persons is relevant to the question whether these patients should be treated like their fellow dependent cognitively Inhibitors,research,lifescience,medical competent patients, or differently; namely, whether they should or should not be offered life-sustaining treatment when such treatment would be offered to other dependent patients. IS THERE A MORAL OBLIGATION TO PROVIDE LIFE-SUSTAINING TREATMENT see more TO PLCC PATIENTS? Good Ethics Starts with Good Facts The preliminary guiding principle of any ethical deliberation is that good ethics starts with good facts. In this discussion, however, there are more mysteries than facts. We know that PLCC patients are human beings, that some are sentient, and that their life depends on on-going medical care. We also know that most people would not wish to be kept alive in this state, which is regarded by our society as “worse than death”; and there are even cases in which we have the patient’s advance directives not to be kept alive in such circumstances. Yet, we do not know for certain that they lack consciousness22 or fail to perceive pain.