ANH and PDE

Take it that the intentional death of a human being is inherently wrong, so that on R-PDE, accomplishing a human death would be morally wrong.  So on R-PDE the death of a human can at most be a foreseen consequence.  Still, this consequence can be defeated via the proportionality constraint.  

So it’d be wrong to withdraw ANH with the intention of killing a patient.  It’d also be wrong to withdraw ANH so that one can instrumentally use the patient’s death as a means of relieving the cost and suffering associated with the patient being alive.  

Still, it’s isn’t wrong to give up a resuscitation after multiple prolonged attempts.  The idea that we have an obligation to preserve life at all costs isn’t right.  Even Roman Catholic teaching holds that removing a ventilator is permissible.  So why not ANH?

The abandonment of resuscitation efforts can be easily justified on R-PDE.  The doctor aims to dispense with the treatment, and not with the life.  The doctor is not intending that the patient die; they’re merely accepting it as a consequence of their giving up medical efforts.  Nor do the withdrawal of these medical efforts constitute the death, nor are they the cause of the death. Nor is the doctor intending the death of the patient as a means to quit the medical efforts. So R-PDE permits this sort of practice.  There’s presumably an underlying condition that is the cause of the patient’s death. This can be easily drawn to the removal of a ventilator. (But even accomplishing the cause of a death is permissible on R-PDE, so long as the death itself doesn’t count as an accomplishment.)

Removal of ANH isn’t in principle an inherent wrong.  If we suppose a technological society in which ANH is just as difficult, expensive, and painful as a ventilator or an amputation, then withdrawing or rejecting ANH would be exactly parallel to the removal of a ventilator. So if the removal of ANH with death seen as a mere consequence of one’s action, it can in principle be justified.

Some have suggested that withdrawing ANH versus withdrawing a ventilator can be differentiated in that in the former case, there isn’t an underlying health condition that leads to death, while in the latter case there is an underlying condition that causes the death. But there is an underlying condition in ANH: The inability to swallow.  So I don’t think this line of argument is successful.

The proportionality criteria is doing the lion's share of the work in prohibiting the practice.

In the case of repeated resuscitation, the gaining of a few moments of life at the expense of a prolonged and intense medical effort does not balance out, favoring a cessation to the medical effort.  Presumably something similar to the ventilator can be said.  But what about ANH?

ANH does not require as intense an effort as the ventilator, and those who depend on ANH are not typically in an immediate danger of death.  ANH can, generally, also be performed in a relatively cheap fashion; with its usage possible in a home setting, and the necessary food not being prohibitively expensive.  This situation offers an analogy:  ‘[imagine] a husband withholding needed insulin from his wife: since the administration of the insulin is not very burdensome, the withholding of insulin is probably chosen as a means of avoiding other burdens, ones associated with the continued life of his wife—but those are avoided only if the wife is dead, so the insulin is probably withheld as a means of bringing about death. In both cases death is intended, and the means chosen to bring it about are omissions.’

Moreover, those PVS patients who depend upon ANH are not, contrary to popular thought, worthless.  Their mere life, even in an unconscious state, is immensely valuable.  Humans are their animal bodies, so these people continue to live as long as the animal which they are continues to live.  Just as a tree or a gecko has value in their lives, so too does an unconscious human.  Moreover, it’s appropriate to value a sleeping friend who will be executed immediately upon awakening.  That seems appropriate, despite the lack of consciousness or even future consciousness.  Nor does letting a PVS patient die benefit them, for they are not suffering.  These patients also offer their caregivers a chance to care selflessly for another, to have solidarity with the patient. 

We can also offer a quick slew of additional arguments:  The methods used to test whether a patient is conscious or not is fallible.  There may be minimally conscious states.  The diagnosis of someone in PVS is relatively certain after specific time periods, but is not infallible, and there are cases of people recovering from PVS.

Further: One may choose for oneself to reject ANH if the situation is ever to come about that they become comatose; this is not necessarily a choice to kill oneself.  They can be merely intending that they avoid the burden such a situation puts on others, and willing the means of having ANH withdrawn.  Willing ANH withdrawn is not willing oneself death, which would be sucide and wrong, but rather willing the cause of the death.  This is a permissible stance according to R-PDE.  Similar to how a soldier who jumps on a grenade to save others intends to absorb the kinetic energy of the explosion, and does not intend their own death.  They merely intend the cause of their death.