Death is a natural consequence of birth and this concept is inherent to our existential philosophy. That death is inevitable and has its own predetermined timing is central to the belief of all major religions. Certainly, death is less complex than one would first think. And yet, death, wherever it occurs, has the potential to provoke controversy.
Donald Herbert, a New York fireman, had suffered severe brain injury in a fire accident a decade ago after which he remained blind, barely able to utter monosyllables or to recognize friends and relatives. Miracles do happen, for on May 3 this year he regained complete clarity of thought and memory along with his speech. His story was carried by all major news networks giving a boost to anti-euthanasia (mercy killing) campaigners. Here was the perfect case against pulling the metaphorical plug on medically unsalvageable patients.
The recent demise of the vegetative Terri Schiavo, effected by the withdrawal of her feeding tube, was the spark that ignited anew the debate on mercy killing. Fundamental to this debate is the belief of anti-euthanasia campaigners that terminally ill or seriously brain-damaged patients like Schiavo, remain living human beings, and so their intrinsic value remains the same as anyone else’s. On the other hand, there are those who argue that withdrawal of care only means helping such people die in dignity and comfort.
The question that caregivers around the world really wish to ask is whether they should be required to make dying last longer than it naturally would?
Advances in medical technology have unfortunately contrived to produce scenarios where this occurs quite frequently. As a consequence, the world of medical science regularly flares with emotive and complex debates about how to handle the final stages of life.
For physicians around the globe, it is becoming increasingly clear that our purpose in this profession is chiefly to make life more comfortable, not to prolong life. Life and death proceed with their own predetermined ordination. However, not infrequently we do quite the opposite with our well-intentioned zeal to save the patient. Subsequently, when realization dawns that the beating heart has produced no joyous life but has only prolonged the misery, life-preserving nutrition or treatment is sought to be withdrawn. Such was the case that Terri Schiavo’s husband petitioned with success in the US judiciary.
When is life worth living and when is it appropriate to end it? More importantly, who decides when to end life? When it became apparent that death was inevitable, Pope John Paul II made it quite clear that he would not like to be put on life-support equipment or even readmitted to the hospital. Going by the church’s own standards, should the pontiff not have sought to prolong or sustain his life by any medical means available? When patients suffering from terminal illnesses are given the right not to opt for medical intervention, what was so wrong, ask some experts, with expecting the same for Terri Schiavo?
Earlier this year, another case attracted similar media attention. Staff Sgt. Johnny Horne of the US military was imprisoned for killing an Iraqi civilian whose death was imminent (as testified by the on-hand medic) from the severe injuries that he had sustained. Evidently, Horne’s deed tantamount to “mercy killing” that is punishable by the US military’s code of conduct.
In a commonplace scenario, doctors routinely prescribe pain-relieving medications to the terminally ill patients with the potential “other effect” of precipitating death. The difference between the two scenarios is that the soldier availed a bullet rather than a drug in trying to put what to him was the tormented soul out of his misery.
Medical practitioners frequently find themselves in situations where they get to determine which life is worth living and which is not. Their calculated decisions on when to withhold, withdraw and, in some instances, render treatment has the very real prospect of precipitating death. Does then the possession of a medical degree impart the right to partake of such decisions?
There is some support for selective care withdrawal within the medical community. The belief that preservation of life is absolute, especially if it requires the use of technology that is insufficiently beneficial or excessively challenging is being questioned by those who believe that the gradual devastation of life can be more oppressive than death itself. Dr. Jack Kevorkian adapted this principle to those whom he assisted in their suicide bid — more than 130 people!
Euthanasia is not just a medical dilemma, but more so a religious and ethical one. Christianity, Judaism and Islam speak with one voice on this issue. In religion, life is sacrosanct and above the travails of human suffering. Ethical arguments frequently stray into religious boundaries.
But passive euthanasia, in varying degrees, is practiced everywhere. The fact that it is not trumpeted does not mean that it does not exist. Withdrawal of care, as with Terri Schiavo, or assisted suicide along the Kevorkian paradigm is only one end of this spectrum that today’s society is loath to accommodate. However, the other end of the spectrum houses an ethical case for regulated withholding of care for the terminally ill, like the pope, to die in comfort. This end favors little controversy.
Can a consensus of moderation then be defined which can address both ends of the ethical divide? Perhaps we can. The imperative is to find the acceptable religious framework to do so. Until then, Donald Herbert’s recovery would remain a rare miracle in the medical field where more often we agonize with the reality of Terri Schiavo.
— Dr. Faisal Sanai is a Saudi physician at the Armed Forces Hospital in Riyadh. ([email protected])
