Bioethicist Jacob Appel on Rom Houben.

From Appel's blog at HuffPo:

Opponents of the right to die appeared to savor a public relations victory with the reported "rebirth" of car-crash victim Rom Houben, a forty-six year old Belgian man who is said to have spent twenty-three years trapped immobile in his own body. Dr. Steven Laureys, a leading neurologist and well-respected coma expert based in Liege, used brain imaging techniques not available at the time of Houben's accident to argue that his patient was "locked-in" and fully conscious, rather than relegated to a vegetative state. A speech therapist, Linda Wouters, now claims that she has helped a grateful Houben to communicate with the outside world using a touch-screen keyboard. If Houben's story does live up to the media hype--and many authorities in the field are not yet convinced--conservative activists may attempt to use his tragedy as an argument against withdrawing care from those believed to be persistently comatose. However, should Dr. Laureys prove correct in his belief that many other patients are similarly imprisoned, these calamities may instead offer a compelling argument for withdrawing such care. In fact, such circumstances might present the rare occasions when active euthanasia is morally justified without overt consent.

snip

When a "locked-in" individual can express a preference for life or death, respect for autonomy strongly suggests that such a wish be honored. No conscious individual should ever be euthanized against his wishes merely because he is not socially productive, or because his care is costly, or because a panel of bioethicists believes that his life is not worth living. The problem is that few individuals ever express their wishes regarding this disturbing set of particular circumstances--one way or another--before they find themselves in a locked-in state. That omission leads to a deeply unsettling question: In cases where no prior preference has been expressed, should the default rule be the preservation of life or should the default be freedom from suffering? One solution might be to survey the population and to establish the majority preference as the default. Another might leave the decision in the hands of family members. Or we could even conclude that some forms of suffering are so horrific that a few patients may have to die against their preferences so that others will not have to undergo years of unremitting psychological agony.