Ethical issues in the treatment of patients with a remitting vegetative state

A case of remitting vegetative state is presented illustrating the need to draw a distinction between persistent and remitting vegetative states in brain-damaged patients. Standard ethical considerations regarding dying patients cannot be universally applied to remitting vegetative states, which are best handled in a context of an ethics of discretion, rather than an ethics of rules. Ethical obligations towards such persons are presented. When the patient cannot assent to withdrawal of treatment, it is suggested that decisions be made on the side of preserving life until the course becomes evidently downhill.