From the persistent vegetative state to the minimally conscious state: Ethical implications of disorders of consciousness

The editors of this volume invited me to write a chapter about the “persistent vegetative state.” It was an understandable request, but only when we consider the diagnosis as part of a larger story involving the relationship between brain injury and the evolution of American bioethics. Seldom has a clinical category done more to transform medical practice than the vegetative state and its related conditions. The debate over these brain states helped to transform the discussion of death and dying in America and to launch the place of bioethics in our society. Indeed, it would not be hyperbole to assert that this discourse played a key role in the birth of bioethics (Jonsen 1998).