Medical Benefit Is ALWAYS Patient Determined

The value or benefit of any medical intervention can be assessed on two dimensions.  First, the intervention can be assessed physiologically (e.g. does it restore function to an organ).  Second, the intervention can be assessed subjectively from the patient's values and preferences.



Established legal and ethical principles hold that the patient's subjective assessment controls.  For example, while a blood transfusion may provide a physiological benefit, it is not a benefit (but actually a harm) to a patient who refuses it for religious reasons.  



But this principle is far more controversial when applied in the opposite situation in which there is no physiological benefit but there is subjective value.  Can we really say that continued physiological support after the determination of death by neurological criteria provides no benefit.  It may provide no physiological benefit.  But if subjective assessment of value and benefit controls, then continued physiological support does confer a benefit.