title: Attitudes of Lay People to Withdrawal of Treatment in Brain Damaged Patients.
abstract: BACKGROUND
  Whether patients in the vegetative state (VS), minimally conscious state (MCS) or the clinically related locked-in syndrome (LIS) should be kept alive is a matter of intense controversy. This study aimed to examine the moral attitudes of lay people to these questions, and the values and other factors that underlie these attitudes.
  
  
  METHODS
  One hundred ninety-nine US residents completed a survey using the online platform Mechanical Turk, comprising demographic questions, agreement with treatment withdrawal from each of the conditions, agreement with a series of ethical principles and three personality tests.
  
  
  RESULTS
  More supported treatment withdrawal from VS (40.2 % agreed, 17.6 % disagreed) than MCS (20.6 %, 41.2 %) or LIS (25.3 %, 35.8 %). Agreement with treatment withdrawal was negatively correlated with religiosity (r= -0.272,P< 0.001), though showed no significant relationship with need for cognition or empathy, and only a partial association with utilitarian judgment in a standard moral dilemma. Support for treatment withdrawal was most strongly associated with endorsement of the importance of patient autonomy, dignity, suffering, best interests. Distributive justice was not given significant weight by most. Importantly, agreement with treatment withdrawal was noticeably higher when considered from a first as opposed to third person perspective for VS (Z= -6.056,P< 0.001), MCS (Z= -6.746,P< 0.001) and LIS (Z= -6.681,P< 0.001).
  
  
  CONCLUSIONS
  Lay attitudes to withdrawal of treatment in brain damaged patients are largely shaped by values similar to those central to the secular ethical debate. Neither traditional values such as the sanctity of life nor utilitarian values relating to resource allocation seem to play a central role. Far greater weight is given to autonomy, which may explain why participants were far more willing to endorse withdrawal of treatment when the issue was presented in the first person, or in relation to a concrete case involving a patient's explicit wishes. Surveys focusing on abstract cases presented in the third person may not provide an accurate picture of lay attitudes to these critical ethical questions.
authors.affiliation: Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia.
authors.forename: Jacob
authors.initials: J
authors.lastname: Gipson
authors.affiliation: Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK.
authors.forename: Guy
authors.initials: G
authors.lastname: Kahane
authors.affiliation: Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK.
authors.forename: Julian
authors.initials: J
authors.lastname: Savulescu
keywords: Disorders of consciousness; Locked in syndrome; Minimally conscious state; Moral psychology; Vegetative state; Withdrawal of treatment