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March 28, 1986

Predicting the Outcome From Hypoxic-Ischemic Coma: Ethical Implications

Author Affiliations

Michigan State University East Lansing

JAMA. 1986;255(12):1571. doi:10.1001/jama.1986.03370120045014

To the Editor.—  Dr Black's editorial1 on predicting the outcome from hypoxic-ischemic coma correctly notes that predictors of bleak prognosis pose important ethical implications and that some of the key ethical assumptions may remain implicit and unexamined if one moves too quickly from prognostic judgments to public policy decisions. I question, however, his suggestion that a consequentialist analysis lies specifically at the root of any decision that one should withhold life-prolonging treatment from an irreversibly comatose patient.Consequentialist or utilitarian ethics are frequently contrasted to a deontological (rights- or duty-oriented) ethical approach. A fundamental deontological question therefore becomes what is required before one could be said to be the subject of rights and duties (since it is obvious that we should respect the rights of other normal human beings but that we should not worry about respecting the rights of trees and rocks). While opinions differ, one useful line of