Deontological and utilitarian ethics: a brief introduction in the context of disorders of consciousness

Purpose: The aims of this paper are to discuss three different ethical frameworks; to briefly consider some of the philosophical positions concerning the nature of personhood. Clear consideration of these issues demonstrates the complexity of decision making in persisting disorders of consciousness. Method: Three different ethical frameworks, Kantian deontology, act utilitarianism and rule utilitarianism, are described and three different accounts of personhood are presented and analysed. Results: These result in very different approaches to the management of patients in permanent vegetative states (PVSs), making it possible to argue for withdrawal of clinically assisted nutrition and hydration in all cases, considering the issues on a case by case basis or continuing to treat all patients whatever their wishes. Conclusions: These results explain why doctors often have different views on how to treat patients in PVS, particularly with regard to the withdrawal of clinically assisted nutrition and hydration. Understanding such issues may help clinicians articulate more clearly the reasons for their intuitions surrounding the management of patients in PVSs.