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DEAD OR ALIVE? NOT ONLY A MATTER OF CONSCIOUSNESS: MORAL PRINCIPLES AT WORK Andrea Manfrinati*§, Davide Rigoni**, Lorella Lotto* *Department of Developmental Psychology and Socialization, University of Padova **Department of General Psychology, University of Padova §andrea.manfrinati@unipd.it

INTRODUCTION Recent neuroimaging studies are revealing previously undetected indirect indices of awareness in patients with a diagnosis of persistent vegetative state (Owen et al., 2006; Monti et al., 2010). These results have several important implication, not only from the medical point of view, but also in the realm of end-of-life questions. For example, the personal story of Eluana Englaro, the young Italian woman who died after a period of 17 years in vegetative state, had been at the center of a civil battle that deeply perturbed the Italian public opinion. Since 1999, Eluana’s father asked repeatedly for the right to remove the feeding tube, saying it was his daughter’s wish not to be kept alive artificially. The issue around the right-to-die divided the nation and gave rise to a severe debate among those who vehemently opposed to the removal of Eluana’s feeding tube, saying it was comparable to euthanasia, which is illegal in Italy, and those who favored it, because that was her will. What is reasonable to assume is that these two contrasting positions subtend different moral principles in which people trust In this study, we hypothesized that the perception of the patient’s life/death state depends on the severity of the pathologies. We expected that people that have a more lay interpretation of the concept of personhood show a gradient in satisfying the request of the patient in the case he/she refused (or expressed the will to refuse) any form of treatment, that could be observed in passing from less severe pathologies to more severe pathologies. On the contrary, we hypothesized that people that consider the life as a gift and, for this reason, as “sacred” don’t show a gradient in satisfying the patient’s request in relation to the perceived gravity of pathologies. *THE “FREE WILL” PRINCIPLE

**THE “SACRALITY OF LIFE” PRINCIPLE

People have the right to decide their own life. No one may be obliged to undergo any given health treatment except under the provisions of the law. The law cannot under any circumstances violate the limits imposed by respect for the human person.

The human life is sacred. No one can under any circumstance claim for himself the right directly to destroy an innocent human being. The Sacrality of Life principle do not consider the human being as a simple living being, as he/she has a transcendent quality that characterize his/her existence as a person.

The Free Will principle emphasize the role of human free will, and ascribe to the human being the right to decide on her/his own life.

RESULTS

METHODS

•Participants (N=203) were faced with one scenario containing a description of a patient suffering from a pathology corresponding to each of the four experimental conditions (Terminally Illness - TI, Locked-in Syndrome - LI, Minimally Conscious State - MCS, Permanent Vegetative State - VS; between subjects). •After reading the scenario, participants were asked to rate, using a 11-point scale, ranging from 0 to 100, how “live/dead” (Status Perception, betweensubjects) was the patient described in the scenario,

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•and to what extent it was appropriate to satisfy the request of the patient in the case he/she refused (or expressed the will to refuse) any form of treatment (Appropriateness). •Then, participants had to express their agreement (using a 10-point scale, ranging from 1 to 10) with two statements, describing two moral principles regarding the end-of-life issues: The Free Will* principle and the Sacrality of Life** principle CONCLUSIONS

While we expected differences in Appropriateness between people endorsing different moral principles, the results on Status Perception were not predicted. However, this findings are very intriguing and they can be of help in making sense why people are so divided in their judgment about the end-of-life issue. The question of consciousness remain very controversial both within and outside neuroscience, and this study indicate that “being conscious” is not a well-defined concept. It simultaneously means many different things to different people depending on the moral principles they endorse.

1-2. An ANOVA was performed with the 4 pathologies as between-subjects factor. The factor was significant (F(3,199) = 31.41, p < .001, η2 = .321). In particular, the VS patient was considered as “more dead” as compared to the other pathologies (M = 59.22, SD = 28.41). Thus, participants rated VS as more severe than the other medical conditions. 3-4. Two separate linear regressions were run on Status Perception and Appropriateness in order to evaluate how the two moral principles (Free Will and Sacrality of Life) modulated the evaluation of the life (or death) status of a patient, and the appropriateness in satisfying the patient’s request to refuse any form of treatment: Status Perception (3): The results showed a significant interaction between Type of Pathology and Free Will principle, indicating that for those participants who endorsed this principle, the more severe the pathology, the more they considered the patient as “dead”. On the contrary, the interaction between Sacrality of Life principle and Type of Pathology did not reach significancy, suggesting that participants who endorsed this principle did not change their judgment on the perceived status of the patient on the basis of the severity of his/her pathology. Appropriateness (4): The results indicated that those participants who agreed highly with the Free Will principle provided high ratings in considering appropriate to satisfy the request of patients, whereas those participants who agreed highly with the Sacrality of Life principle expressed lower rating on this request.


Dead Or Alive?