The persistent vegetative state and anencephaly: problematic paradigms for discussing futility and rationing

Medical futility has been a controversial issue for the last several years. Although anencephalic infants and patients in the persistent vegetative state (PVS) have often been suggested as paradigmatic cases for discussing the issue of medical futility, there is no consensus among physicians or ethicists that treatment of such patients is futile and courts have not supported the futility argument. Focusing on the issue of medical futility will not resolve the management issues surrounding the care of patients in PVS or anencephalic infants. Instead, an analysis of the benefits and burdens of treatments offers a potential solution by demonstrating that the real problem is the dissociation of the benefits and burdens of treatment for such patients. We propose the idea that anencephalic infants and patients in PVS provide an appropriate paradigm for discussing the issue of rationing of health-care resources.