With the development of medical technology, society is placed in unique ethical dilemmas, which are not easily answered by scriptural commands concerning the preserving and taking of human life. Of these, the most complex is the capacity to preserve life long after the capacity for cognitive life is lost.
The dangers in making choices that demean human life are numerous, but it is the anxiety of those forced to choose life or death by these options that seems more apparent to those involved. The struggle whether or not to use “life-saving” means for a loved one is illustrated well by the couple Paul and Judy, who, while agreeing against long-term artificial death prevention, do not agree on whether the intravenous supply of food and water is artificial.
Paul’s father, Gardner, died amid uncomfortable circumstances. Years ago, circulation problems were threatening Gardner’s life, while worsening dementia was preventing his cooperation in treatment. Paul placed him in a nursing facility to save his legs and life, and became his medical proxy. Paul’s power, however, only took effect if Gardner was unconscious, despite his obvious mental deterioration. After several semi-comfortable years in the home, Gardner’s mind could no longer recall short-term information of any kind. He was confused, frustrated, and completely uncooperative.
His life-threatening medical conditions returned because the doctors refused to press Gardner into compliance, insisting that he had a legal right to refuse treatment, dementia notwithstanding. When Gardner stopped eating, and drinking, and refused all medication, Paul attempted to get his father nutrition and fluids through other means, but the doctors fought him on the issue. “He is dying,” they said, “Let him die.”
Paul, however, though willing to let him die, did not want to speed the process through basic neglect, reasoning that “It is wrong to deny a person food and water by whatever means they might get it.” When Paul insisted, the doctors claimed that they had tried to give him such care, but that he had resisted. Paul did not press the issue further. Gardner died within a week. Paul said, “I, myself, would die in a week without food or water.” He felt that the doctors and nurses demonstrated a lack of concern for Gardner’s well-being, “…as if they were anxious to hasten his death.” Wishing that he had been more forceful, Paul insists that he would not allow the doctors to take the same course of action with his mother.
Judy, Paul’s wife, brought her mother, Thelma, to live with her after discovering that she was showing early symptoms of Alzheimer’s. When Thelma became too violent and accident prone in her confusion, however, Judy was forced to place her in specialized care.
The nursing home readily recognized Judy’s medical proxy authority because of Thelma’s condition, and permitted her to place “do not resuscitate”, and “no heroic measures” orders on Thelma’s official chart. These measures were tested when Thelma choked “to death” while eating a meal. Interpreting the intent of Judy’s instructions not to include such unnatural occurrences, the nurses resuscitated her, and placed her on a liquefied diet. While Judy agreed and did not want an unnatural death for her mother, she decided that when Thelma could no longer remember how to swallow, she would allow her to die without intravenous food and water.
Judy feels that when a person has no reasonable chance to recover from a fatal illness that has robbed them of the ability to eat and drink, that they should be allowed to die. The contrasted confidence with which Judy has made such choices is obvious. She accredits this to a long-standing history with Thelma, who made similar choices, by request, on behalf of her parents and husband at a time when such extreme care measures were less common. Judy was also more confident in Thelma’s care providers. She was involved in every choice made for her, and was contacted in the event of even minor happenings such as a harmless fall, or a shift in behavior.
I have always believed that a person should not be kept alive artificially if they have no real hope of recovery, but have not tended to include food and water provisions as artificial preservation. In agreement with Paul, I think most people would die within a week if not given food and water. Hence, I feel that refusing easily provided nourishment is not “leaving things in the hands of God,” nor “permitting a natural death,” but is murder by neglect. Indeed, I have friends who are past coma victims; one remained in a coma for over a year before making a full recovery. I am nervous about the ethical slide which medicine will take if allowed to routinely starve its long-care patients.
There are people, however, whose circumstances leave neither a reasonable, nor a remote chance for a recovery of cognitive existence, who might ethically be allowed to succumb to their body’s inability to eat and drink. The haste of expedience, however, makes such a precedent dangerous for all involved.
The challenge in these issues, however, is found in their relative newness. It has not been very long at all, since any unconscious state, even one from which one might wake within days, was an automatic death sentence. Our incapacity to save eradicated any ethical plight in the matter.
What do you think?
