When has 'life' ended?
Just what does it mean to be alive, or at least to have a life worth living? Two recent cases one national, the other local have forced reconsideration of the most basic questions of human life.
While the cases are fundamentally different, they shared two elements: Both were preventable tragedies and both had family members who refused to accept hard, scientific evidence that ran contrary to their hopes.
Fifteen years ago, probably as the result of an eating disorder, Terri Schiavo's heart stopped for long enough that her brain became oxygen-starved. The resulting damage was so profound that her cerebral cortex was essentially destroyed.
Was she left alive? Yes. Despite the damage, her brain stem, which controls heart, lungs and other autonomic operations, was fully functioning.
Despite these capacities, however, she could not speak. She could not intentionally move her limbs. She had no control over bodily functions. She could not recognize others. And she had no memory. In short, she simply could not think.
How do we know this? Because, again, her cortex, the source of human thought, was irreversibly destroyed. This could be seen on MRI scans of her brain. As a leading neurologist put it, where her cortex once was, there was now only fluid. The scientific facts were simply irrefutable.
What should we make, then, of her parents' claim that she recognized them, that she tried to speak, and that she "tracked" objects around the room? As with any test of evidence, the standard of verification is whether those facts are available to other, neutral parties. Multiple judges determined no such independent evidence existed. Sadly, the thinking, loving, engaging, person who was Terri Schiavo was gone.
Does that mean her life was not worth living? The answer is terribly complex in that each of us has differing standards as to what counts as minimal quality of life. While there is considerable overlap on those standards (e.g., most say they would not want to be in a vegetative state or in intractable pain), there is also significant disagreement (e.g., on whether a profound reduction in mental capacity or a complete loss of sensory awareness would be acceptable).
Yet the answer is also simple, since, in the end, it has to be our decision. The most basic of moral principles respect for autonomous choices prevails in this and all similar cases. And, unless there is clear and overwhelming evidence to the contrary, spouses are universally accepted as the best surrogate, when the patient is unable to make the decision herself.
Was removing her feeding tube "playing God?" Probably. But if it was, so was the initial intervention that saved her life, along with the hundreds of other similar interventions over the last 15 years.
Why is it that we consider it interference when we end life, but not when we partake of all our technological gadgets to prolong it, far beyond what any "natural" course would have produced?
For all the complexities of the Schiavo case, the Daniel Provencio case was quite straightforward, or at least it should have been.
Provencio, struck in the head by a rubber bullet during an altercation at Wasco State Prison, also received massive brain trauma. But, unlike Schiavo, Provencio suffered whole brain damage, again proven through MRI scans and, in his case, also through EEGs and clinical evidence.
All parts of his brain, including his brain stem, were irreversibly destroyed. Although oxygen was being forced into his lungs by a machine and his heart was kept beating through the use of drugs, Provencio was, in fact, brain-dead. By legal criteria in all 50 states, he was, quite simply, dead.
For reasons that still have not been made clear, however, no one from the prison medical system was willing to make an actual declaration of death. Instead, Provencio, literally now a dead body, was kept shackled to a high-cost bed at Mercy Hospital, with 24-hour armed guards and tightly restricted family visitations. And because he was still technically a prisoner, hospital physicians did not have the legal authority to declare him dead.
As one could imagine, this obviously gave the family incredibly mixed messages: "We're sorry, your loved one is dead. Of course, we have to keep him chained to a bed and watched over by guards, and you can visit him for only an hour a day, but trust us, he really is dead."
This confusion was further exacerbated by The Californian'scoverage, which repeatedly used "brain-dead, but being kept alive" language. Is it any surprise the family simply reached the point where they trusted no one?
At least three important lessons emerge from these cases.
* First, despite that physicians routinely botch the humane side of their practice, when they have the hard science, we do no one any favors by irrationally refusing to accept it.
* Second, everyone needs to be much more careful to distinguish "brain death" from "brain damage." The first simply means dead; the second can mean anything from damaged but should fully recover, to damaged to the point of a permanent vegetative state.
* Third, unless you want the end of your life to be like Terri Schiavo's, please talk with your loved ones about what you think counts as a minimal quality of life. And then put those conversations in writing in the form of a durable power of attorney for health care.
Christopher Meyers is a philosophy professor at Cal State Bakersfield, with a speciality in medical ethics. He also is director of the Kegley Institute of Ethics. The views expressed in this article are his own. E-mail him at cmeyers@csub.edu.
