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Predicting the Outcome From Hypoxic-Ischemic Coma: Ethical Implications-Reply

Peter McL. Black, MD, PhD
JAMA. 1986;255(12):1571. doi:10.1001/jama.1986.03370120045015.
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In Reply.—  I am grateful to Dr Brody for correcting any impression I may have left that consequentialist analysis is necessary to withhold treatment in comatose patients. Nonconsequentialist analysis can certainly lead to the same conclusion, for example by deciding that the irreversibly comatose patient is not a "person." Consequentialist analysis is, however, implicit in the article by Levy et al1 that was under discussion. The fundamental ethical stance of the President's Commission2 may or may not be consequentialist; their claim that continued maintenance of a permanently unconscious patient can constitute "an irresponsible stewardship of society's resources" (p186) appears to rest on consequentialist cost-benefit considerations. I do not find convincing support for the preconditions for their analysis that Dr Brody mentions in his penultimate sentence; moreover, the "incompetent but noncomatose" patient is not the patient under consideration here.Consequentialist analysis is not necessarily bad and nonconsequentialist analysis is


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