Gipson Jacob, Kahane Guy, Savulescu Julian
Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia.
Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK.
Neuroethics. 2014;7(1):1-9. doi: 10.1007/s12152-012-9174-4. Epub 2013 Jan 5.
Whether patients in the vegetative state (VS), minimally conscious state (MCS) or the clinically related locked-in syndrome (LIS) should be kept alive is a matter of intense controversy. This study aimed to examine the moral attitudes of lay people to these questions, and the values and other factors that underlie these attitudes.
One hundred ninety-nine US residents completed a survey using the online platform Mechanical Turk, comprising demographic questions, agreement with treatment withdrawal from each of the conditions, agreement with a series of ethical principles and three personality tests.
More supported treatment withdrawal from VS (40.2 % agreed, 17.6 % disagreed) than MCS (20.6 %, 41.2 %) or LIS (25.3 %, 35.8 %). Agreement with treatment withdrawal was negatively correlated with religiosity ( = -0.272, < 0.001), though showed no significant relationship with need for cognition or empathy, and only a partial association with utilitarian judgment in a standard moral dilemma. Support for treatment withdrawal was most strongly associated with endorsement of the importance of patient autonomy, dignity, suffering, best interests. Distributive justice was not given significant weight by most. Importantly, agreement with treatment withdrawal was noticeably higher when considered from a first as opposed to third person perspective for VS ( = -6.056, < 0.001), MCS ( = -6.746, < 0.001) and LIS ( = -6.681, < 0.001).
Lay attitudes to withdrawal of treatment in brain damaged patients are largely shaped by values similar to those central to the secular ethical debate. Neither traditional values such as the sanctity of life nor utilitarian values relating to resource allocation seem to play a central role. Far greater weight is given to autonomy, which may explain why participants were far more willing to endorse withdrawal of treatment when the issue was presented in the first person, or in relation to a concrete case involving a patient's explicit wishes. Surveys focusing on abstract cases presented in the third person may not provide an accurate picture of lay attitudes to these critical ethical questions.
对于处于植物人状态（VS）、微意识状态（MCS）或临床相关闭锁综合征（LIS）的患者是否应该维持生命，这是一个极具争议的问题。本研究旨在探讨普通民众对这些问题的道德态度，以及构成这些态度的价值观和其他因素。
199名美国居民通过在线平台Mechanical Turk完成了一项调查，调查内容包括人口统计学问题、对每种情况撤掉治疗的认同度、对一系列伦理原则的认同度以及三项人格测试。
比起微意识状态（20.6%同意，41.2%不同意）或闭锁综合征（25.3%同意，35.8%不同意），更多人支持撤掉植物人状态患者的治疗（40.2%同意，17.6%不同意）。对撤掉治疗的认同度与宗教信仰呈负相关（r = -0.272，p < 0.001），不过与认知需求或同理心没有显著关系，在一个标准道德困境中与功利主义判断仅有部分关联。支持撤掉治疗与对患者自主权、尊严、痛苦、最大利益重要性的认可关联最为紧密。大多数人没有赋予分配正义显著权重。重要的是，从第一人称视角而非第三人称视角考虑时，对于植物人状态（r = -6.056，p < 0.001）、微意识状态（r = -6.746，p < 0.001）和闭锁综合征（r = -6.681，p < 0.001），对撤掉治疗的认同度明显更高。
普通民众对脑损伤患者撤掉治疗的态度很大程度上是由与世俗伦理辩论核心相似的价值观塑造的。诸如生命神圣性等传统价值观以及与资源分配相关的功利主义价值观似乎都没有起到核心作用。自主权被赋予了更大权重，这或许可以解释为什么当问题以第一人称提出，或者涉及患者明确意愿的具体案例时，参与者更愿意认可撤掉治疗。关注第三人称呈现的抽象案例的调查可能无法准确反映普通民众对这些关键伦理问题的态度。
