Chapter 10 Moral Conflict in the Minimally Conscious State

Abstract

In the next section, I sketch a view in which the possession of phenomenal consciousness (henceforth: “consciousness”) is necessary for possession of (positive or negative degrees of) subjective well-being. It would seem that the possession of consciousness supplies caregivers reason to enhance the well-being of MCS patients. Unfortunately, as I discuss next, matters are complicated by a certain kind of moral conflict that arises in decision-making situations regarding MCS patient care. In many cases, it seems difficult, and perhaps impossible, to respect an MCS patient’s autonomy—as embodied in her autonomously expressed prior wishes or in the wishes she would presently autonomously express were she competent to do so—while promoting the well-being she presently enjoys and will plausibly enjoy in the future. Later, I consider views according to which the moral conflict is only apparent, because considerations of autonomy trump considerations of well-being (or vice-versa). I argue that neither view is satisfying: We are left with genuine moral conflict. However, consideration of these views is salutary, because their weaknesses motivate a mixed view in which considerations of both autonomy and well-being should in many cases be weighed against each other, as well as other relevant moral considerations (e.g., considerations of distributive justice). In the final section, I draw four practical conclusions.