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Friday, March 25, 2005

Death is Rarely Easy

The Terri Schiavo case started a stampede to create living wills, which often include such instructions as, “I do not want artificial nutrition and hydration if that would be the main treatment keeping me alive.” That means no feeding tube, except as a temporary expedient.

My mother wrote such a living will a few years before she died of Alzheimer’s at 90. At the end she refused to open her mouth for food or water, consciously or not. Knowing her wishes, my sister and I were not about to force a tube down her throat.

Although death from Alzheimer’s was imminent and inevitable, the immediate cause of my mother’s death was probably dehydration (which precedes starvation). That is not uncommon at all. On the contrary, that is exactly how many if not most elderly people die if (1) they are not fortunate to die quickly and (2) they have left instructions that they do not wish to be kept alive by artificial means. Those present when my mother died said she did not appear to be in pain, though morphine would have been available if she had needed it. A morphine overdose might well have been more merciful, but laws against euthanasia leave no legal alternative to death by dehydration in many cases. Those who now bemoan death by dehydration usually admire laws against euthanasia, which is somewhat inconsistent when those are often the only two options for those who abhor prolonged artificial life support.

Many people believe themselves qualified to speak in the abstract about such matters, particularly concerning people they do not know. And they claim to view such tough choices as a clear and simple distinction between right and wrong.

I would first like to ask anyone blessed with such moral certitude if they object to living wills in principle (perhaps viewing such an Advance Medical Directive as akin to suicide). If not, I would ask if he or she could possibly imagine writing a living will for himself or herself that would instruct physicians to maintain the body by any means possible, even if the person in question was unable to move or communicate for 15 years (and potentially much longer). If they could honestly answer that question in the affirmative, I would ask how certain they are that such a fate is preferable to being buried alive with an oxygen tube and plenty of food and water.

Many who profess belief in a glorious afterlife have nonetheless become curiously agitated on behalf of clinging to the faintest semblance of life by unnatural means. This makes no theological sense unless Mrs. Schiavo is assumed to be damned, which seems a very unChristian presumption.


Tlaloc said...

Nicely written and insightful.

Anonymous said...

It will be interesting to see whether Sam has any response to this, but here's one answer to the you ask:

The standard that the Florida court purported to use when making its determination whehter Terri Schiavo should be fed or not was what the patient would have wanted for herself. The court, though, considered the question (and you present the question) as an abstraction and made its determination based on evidence of the abstract(and off the cuff) statements of Terri Schiavo. It necessarily ignored some critical evidence that almost certainly would have been relevant to Terri were *she* making the decision herself. Specifically, her parents have now litigated this matter for a decade and been up and down the state and federal court system numerous times and even secured private legislation in Congress for her benefit. This fight has clearly become central to their lives and one can infer, from that fact, that the mere fact that Terri Schiavo lives gives them tremendous comfort and hope. Were Schiavo deciding, herself, whether she should live or die she would almost certainly take into account her parents' desperate wish that, even in the state she is in, she remain alive. That fact may have been sufficent, whatever she would have wanted for herself in the abstract, to sway her decision.

When such things are discussed in the abstract, one tends to think of them solipsisticly and relevant, but probably important, information is ignored. This is a problem inherent in the standard the court purported to apply. It is an even bigger problem, however, for the religious who, as a matter of faith, must recognize that their own lives do not just have meaning to themselves, they have meaning to others -- to God if no one else -- and that the question isn't, and can't be, whether they, themselves, want to go on under the circumstances.

Once this is recognized it must also be recognized that faith may require a heroic sacrifice (the Pope is a prominent current example of such sacrifice). At the same time, the law can hardly require all of us to bear our crosses with the fortitude of a saint. It has to provide some mechanism for coming to a determination about what the best thing to do in such situations is. It's hard to believe that it couldn't provide some mechanism a lot less crappy than the one that exists in Florida though.