This essay aims to deal with the subject of the human rights of people in a permanent vegetative state, for this it will deal with conceptualizing these terms and others related to them, and which are essential for the development and thorough understanding of this subject. The persistent vegetative state will also be explained in detail, differentiating it from the permanent one, for a better understanding of the latter. The reason for the recognition of human rights for people in this state will be exposed, as well as other issues related to this topic.
Person, dignity and human rights.
In the first place, it is worth noting what we understand by a person, specifically a natural person, to be the one that interests the subject in question. The natural or physical person is nothing more than the human being, the man legally speaking, that magnificent union between matter and spirituality, a substance -this being understood by both the essence itself, and the subject that persists over it- that for the simple fact of possessing human nature it is worthy, and to which the Law recognizes personality to participate in the legal traffic.
This ontological dignity, natural to all human beings, without distinction, and will not be lacerated by any physical or moral impairment suffered by the subject (1). Dignity that constitutes the base on which the rights and duties of which the people are holders are sustained, within these, the human rights defined as those powers, and prerogatives that correspond to every human being by the mere fact of being, are those “equal and inalienable rights of all members of the human family” 2.
(1) Differentiating from dignity as a moral value that is earned by virtue of the behavior of the subject. 2 According to the Preamble of the Universal Declaration of Human Rights, approved on December 10, 1948 by the United Nations General Assembly.
It is recognized that every human being possesses that dignity, without discrimination of any kind, constituting an immutable and untouchable value, that will not depend on concrete existential circumstances, nor be subordinated to anyone's judgment. With which the World Federation of Associations of Catholic Physicians expressly agree, specifically in its reflections on the scientific and ethical problems related to the vegetative state. As well as, in the Code of Ethics and Medical Deontology, especially in Article 4.1, of Chapter II: General Principles, which expresses as the doctor's main duties, respect for human life and the dignity of the person and health care. of the individual and the community, as in Chapter VI. Also in the Preamble of the Universal Declaration of Human Rights,This intrinsic dignity is referred to in all human beings.
Vegetative state
Before starting to analyze the dignity and entitlement of patients in a vegetative state, it is necessary to specify some elements in this regard: the individual in a vegetative state does not have the capacity to respond; It is currently defined as a condition characterized by: waking state, alternation of sleep and wake cycles, apparent absence of self-awareness and the surrounding environment, lack of behavioral responses to environmental stimuli, maintenance of autonomic functions and other brain functions.
On the permanent and persistent terms.
Around the application of the terms persistent or permanent to this stage, there have been various criteria, mainly regarding the permanent, since the vegetative state begins to be persistent, but either is reversible or ends up becoming permanent, irreversible. This brings with it important medical consequences, because in that irreversible state the obligations derived from the principle of non-maleficence are very different from those that exist in other circumstances and behaviors that in the permanent vegetative state can be perfectly licit, would be classified as illicit in situations where there is a possibility of recovery.
The term persistent refers to a condition of functional disorder that extends from the past to the moment the patient is examined, and without a definite prognosis for the future; while permanent denotes irreversibility, a patient in a persistent vegetative state becomes permanent when the diagnosis of irreversibility can be established with a high degree of clinical certainty.
Because currently, it is not possible to predict exactly which of the patients in a vegetative state will recover and which will not, since this high degree of clinical certainty is not entirely accurate and it is necessary to create specific clinical criteria for the use of the term permanent. The observation time in the vegetative state to add the qualification of persistent or permanent has varied. Some prefer to wait 12 months after trauma, as well as 3 months after hypoxic damage. Others advocate waiting 1 to 3 months after hypoxic damage and 3 to 6 months after trauma, etc. There are even those who prefer to use persistent, since they accept the possibility of a total or partial neurological recovery.
In accordance with them, it is considered more appropriate to use the term persistent, since permanent infers irreversibility, which is not always the case. Consequently, there has been a tendency to call patients a vegetative state from the beginning and to add the persistent qualifier after an observation period of 1 to 3 months for patients with hypoxic damage and 3 to 6 months for those who suffer traumatic damage..
The patients in EVP are living people.
Although some have defined them as dead, by extending the definition of brain death (ME) to states of permanent unconsciousness, trying to standardize them, which has become an important bioethical controversy of recent times. There are enough scientific reasons to show that they are different and that the patients in EVP are living people. First, while in the ME state the functions of the entire brain have been lost, and it has been scientifically proven that by losing the activity of the upper nervous system there is no life. If we understand that life is the state of activity of organized beings and the maximum representation of that state is the nervous system,one cannot speak of life when there is no demonstrated superior nervous activity - as happens in ME - we will accept that ME is true death, the point beyond which return is not possible. EVP is a clinical condition characterized by unconsciousness with total or partial preservation of the functions of the stem and the hypothalamus. (3) They are human beings who sleep and wake up. And while there is at least some function of the brain structures, we are in front of a living person, they do not meet the criteria of brain death, nor cardiopulmonary. Regarding their life expectancy, it is generally higher than six months, so it cannot be called terminal either. So they are included, or should be included in the category of chronic non-terminally ill patients, which maintains the moral obligation,according to the bioethical principle of non-maleficence, to provide them with all the therapeutic and care means.33
In the clinical picture of patients with PVD, symptoms and signs such as blinking, yawning, responses to painful stimuli, pyramidal signs, emotional expression, alterations in the reflexes of muscular stretching, decerebrate rigidity, among others, have appeared, showing that these patients they are alive.
Deny life support
To stop supplying hydration and nutrition to patients in a permanent vegetative state is to starve and dehydrate them, there are authors who equate it with passive euthanasia. Others classify hydration and also artificial nutrition as forms of medical treatment, and therefore the sick or their legal representatives may decide to end the
(3) Hodelín Tablada, Ricardo: Brain death and persistent vegetative state. Current controversies. Found in: Acosta Sariego, José R (scientific editor): Bioethics from a Cuban perspective. Havana, 2007. Ed. Publicaciones Acuario, Centro Félix Varela
treatment and that there were no ethical differences between stopping treatment or delaying it. Some authors have separated the various positions into two groups: those who think that patients with PVD are worthy of care, of respect, that they cannot be deprived of at least the minimum medical care, of an adequate diet, and those who They maintain that these are not human beings or that even if they are, they are in a state such that life does not deserve to be lived, so they do not consider it obligatory to provide them with specific medical care, and that it could be legitimate to deprive them of life support and let them die.
Dignity and human rights of people in EVP
If all human persons are dignified and dignity is the foundation of the remaining rights, and all men must have equal capacity to be holders of rights and duties, regardless of whether there is any physical or psychological impairment that limits their ability to actually or another distinction, article 2 of the Universal Declaration of Human Rights reaffirms it by establishing that: “Every person has all the rights and freedoms proclaimed in this Declaration, without distinction of race, color, sex, language, religion, political opinion or of any other nature, national or social origin, economic position, birth or any other condition ”.
So people in a permanent vegetative state are living human beings, and therefore worthy and holders of all the rights proclaimed in the Universal Declaration of Human Rights, by virtue of their universal character, therefore they have the right to be guarantee the enjoyment and protection of the supreme goods that are life (4) and human dignity, presupposed for the remaining rights, since they are protected from any type of discrimination or from any act that violates their fundamental rights, by virtue of articles 7 and 8 of said declaration.
From my point of view, following personalist criteria, I consider life to be an absolute value, and that as long as the person is still alive, as is the case
(4) Article 3 of the Universal Declaration of Human Rights which states that: Every individual has the right to life, liberty and the security of his person.
of patients in a permanent vegetative state, it would be an inhumane act to stop supplying nutrition and hydration, also because despite the fact that irreversibility is inherent to the permanent vegetative state, as has been shown even the mechanisms to denote this phase are not very exact and cases have been seen, in which the patient recovers. Therefore, the rights of these people must be respected and given the opportunity to continue living. Furthermore, according to the World Federation of Catholic Medical Associations, in its reflections on the scientific and ethical problems of the vegetative state, it recognizes the dignity and rights of patients in this state, also recognizing other particular rights for these patients, the right to: a correct and deep diagnostic assessment,in order to avoid possible errors and guide rehabilitation interventions in the best possible way; fundamental assistance, covering hydration, food, heating and hygiene; to the prevention of possible complications and the control of any signs of recovery; an adequate rehabilitation process, prolonged in time, that favors the recovery and maintenance of the objectives achieved; be treated like any other patient, with the proper assistance and with affectionate treatment.that favors the recovery and maintenance of the objectives achieved; be treated like any other patient, with the proper assistance and with affectionate treatment.that favors the recovery and maintenance of the objectives achieved; be treated like any other patient, with the proper assistance and with affectionate treatment.
Just as these rights are born for people in EVP, the corresponding duty is born, not only for doctors and institutions, but also for society in general, to guarantee the realization and guarantee of those rights.
Therefore, the decision to suspend feeding and hydration, whose supply to the patient in a vegetative state is necessarily assisted, inevitably and directly results in the death of the patient. By constituting an act of euthanasia, by omission, it must be morally unacceptable. As much as it is a social duty to work so that all human beings have a better quality of life, it does not mean that this can be used as an excuse to let these people die, nor should that decision be made taking into account factors such as age, social position, or others, because there is no life more valuable than another, all human lives are equally important and worthy, without distinction of any kind, and therefore it is everyone's duty to respect the life and dignity of all people, including ours.
Bibliography
Books:
- Acosta Sariego, José R (scientific editor): Bioethics from a Cuban perspective. Havana, 2007. Ed. Publicaciones Acuario, Centro Félix Varela. Article: Hodelín Tablada, Ricardo: Brain death and persistent vegetative state. Current controversies.
- Lolas, Fernando; Quezada, Alvaro; Rodríguez, Eduardo (Editors): HEALTH RESEARCH. ETHICAL DIMENSION, Bioethics Manual. Glossary, Chile, s.ed., 2006, 390p.
-Tealdi, Juan Carlos (director): Latin American Dictionary of Bioethics. - Bogotá: UNESCO - Latin American and Caribbean Bioethics Network: National University of Colombia, 2008, 660 p. art: Hodelín Tablada, Ricardo: Life in a persistent vegetative state. Legislations:
-Universal Declaration of Human Rights, approved on December 10, 1948 by the General Assembly of the United Nations.
- Spanish Code of Ethics and Medical Deontology of 1990. Chapter II: General principles, Article 4.1. Chapter VI: Article 25.1. Article 28.3
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