Monday, January 13, 2014

“In three words I can sum up everything I've learned about life: it goes on.”

Except when it doesn't. 

Wherefore is light given to him that is in misery, and life unto the bitter in soul; which long for death, but it cometh not; and dig for it more than for hid treasures; which rejoice exceedingly, and are glad, when they can find the grave?

Interesting to come home after two hours of ethic discussions on advanced directives, cessation of medical intervention, rights of parents/children/other and read this verse. I also find it somewhat interesting that, in such a situation, doctors have little say. Or rather, we have a lot to say, but no ability to act on what we way. We may only do what the patient or patient's stand-in orders. If they demand less (or more) care than we think medically or morally advisable...we cannot go against their wishes. I'm fairly certain this plays out differently for different practices - as of yet, we cannot be forced to provide care we find ethically repugnant - and of course, sometimes the state steps in and trumps the patient's decision.

As a patient (if not at this moment, at some point in your life), what are your thoughts on that? Do you understand the definition of life? (Honestly, pretty straight-forward.) How about death? (Suddenly not so straight-forward.) Have any of you been following the CA case of the 13 year old who "died" following a tonsillectomy, but whose mother refused/is refusing to allow her to be taken off the ventilator? How about the pregnant TX woman who is also brain dead, but being kept on life support against her previously stated wishes and those of her family until her baby can be born? (I said the state could step in. In the teen's case, there was some question of the state stepping in to allow the hospital to turn off the ventilator. Perhaps also of note in the second case, perhaps not - the baby may be born profoundly retarded. No one can tell at this you think that should have any bearing whatsoever on the case?) 

Is brain dead really dead? Do you know the difference between vegetative state and brain dead and legally dead? You can have a machine pump air and blood into a corpse and that doesn't make it alive...but somehow it is harder to know where that line is when you were using a machine to help a living person breathe, and now brain activity appears to have stopped. Are they dead now? Or still alive? 

Why are there these arguments over keeping people alive, letting them die, causing them to die, preventing them from living...? Why do people force life when others do not want it, or insist on taking it, simply because they do not want it? 

As one of my...colleagues...(I keep wanting to call them classmates; we're working for professionalism, though) brought up today - under the law, if a man kills his pregnant wife, he is guilty and will be prosecuted for double murder. (Presumably, if a man causes a miscarriage, the mother can prosecute him for murder? I haven't checked on that.) If a wife chooses to have an abortion, the husband/father has absolutely no legal recourse. In the case of the TX family, the baby has no say (too young), and the mother's only directives are apparently for herself. Given that she would have had the government-given right to end her baby's life any time she chose before losing the ability to do so...if her husband is now her legal stand-in, does that give him that right? (Apparently not as yet, since the state stepped in and over-ruled his wish/agreement with her wish that she be taken off life-support before the baby is born. Do you think the government/judge's stance will change if at some point it is discovered that the baby will be born in a persistent vegetative state?)

We have so many rules for life and non-life we don't even know where we stand anymore. Are we defending life? Fighting for the right to keep living? Fighting for the right to stop living? Fighting for the right simply to choose whether we live or die? Is there a right to life? Then why not a right to death? Are we playing God when we choose to end life? Then why are we not playing God when we chose to create life? If we are unable to create life...then how are we able to give death?, you tell me. I want to know what you think. Or at least make you think for a moment. Do you have an answer for Job's question? Or for the heartrending cry of all those asking why light had been taken from those who delighted in their life? 

What do you see as the doctor's role in this debate? Who has final say on life? The individual, at some point when they were of sound mind? The parents/significant other? (Someone PLEASE give me another word. I profoundly dislike both significant other and spouse. Not to distract from the matter at hand. It just bugs me.) The doctor? The law? Someone Else? (Keep in mind that you would not be able to call on Him as witness if you were sued...) 
Can we keep someone alive longer than God planned? (That sounds weird, but I couldn't think of another way to phrase it. I hope you know what I mean.) Can we shorten someone's life/cause death earlier than God intended? (Does that sound more right...?) 

And because ethics apparently get me in the mood where I can't shut up, let's say you believe only God can create life, and therefore only He can end life. To hasten death in any way is a sin. (Side question: If you can give someone an excruciatingly painful treatment that will make them live one more day, or let them die peacefully tonight...would it be morally wrong to let them die? I doubt this actually occurs that often in real life. It's an intriguing question, though.) 
Someone in your family gets in a car accident. Because the accident occurred directly in front of a level three trauma center, they were pulled out of the wreck and put on a ventilator almost before anybody knew what happened. After some tests, however, the doctors tell you that your family member is brain dead. All brain activity has ceased; the only thing keeping their heart breathing/lungs pumping is a machine. There is no chance for recovery. (And this is assuming you have had multiple specialists attempting to find any kind of brain activity at all. The person is declared legally dead.) Do you immediately decide to turn off the machine so you stop blowing air into a dead body? Do you arrange for IV's, feeding tubes, catheters, whatever is necessary to keep the body going for however long it can? (Keeping in mind that people don't exactly know how long this is, since most people have not tried it.) What if doing so means you have to pay every penny of the cost? (Except you have no money and need to take out a second loan even to pay for the hospital bills so far. You know doing this is jeopardizing the future/health/lives of the rest of your family.)

Now assume all those things are the same...except the doctors detected what may be brain activity, and your family member has not been declared legally dead. How long will you pay for life support? 

Now what if that person was not someone in your family, but someone you hated. Perhaps one of the horrible dictators everyone likes to use for examples of people who could have been killed before they destroyed millions. Does your answer change at all?

Thoughts on any of these questions? I'd love to hear them... :) 

2 thoughts shared:

Ashton said...

Wow... I hope I'm not supposed to answer all those questions! Hehe :)
I've heard something somewhere about how doctors can have little to say in matters. As a patient (a former one! ;) ) I think I would want to hear what a dr. has to say over a certain matter. Depends on what it is... I don't think I'd do anything rash. *whistles*

I would have said God has a final say on life -- but that might not peel over for some folks out there. I think prayer (for the questions on people on ventilators) is needed. I think the same for extending or shortening someone's life if they are "brain-dead" or whatever you were talking about. lol
Hope that all makes sense. O.o

Katherine Sophia said...

LOL, Ashton...I just kinda wanted to get people thinking about this stuff, since I think it is becoming a real issue in healthcare.

Hopefully no one your family or mine will ever be in this situation...but the family of a friend of mine are right now dealing with the decision to continue attempting to treat their baby with extremely aggressive chemo or to simply give her comfort care and let her go...several years ago, another family friend ended up taking their child off life support after several specialists pronounced him brain dead...It's a strange and complicated thing - and I agree with you that much prayer and being extremely careful to avoid rashness is important! If someone is dead you can always take them off life support as it becomes increasingly evident that they are not alive...but if they weren't dead, it's not going to work to try to hook them back up later for sure.

So I appreciate your taking the time to think about it and comment on the matter! :) I definitely think it's something worth talking about with family and friends. (In an appropriate setting...I can see myself bringing it up at Christmas dinner or something and making everybody mad... :)


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