Caring Advocates Blog & News

"At death's window” by novelist and essayist Anne Lamott, was published by the L. A. Times on June 25, 2006. Although listed under “Opinion: Op-Ed,” it is really a memoir that records a “friend-assisted suicide.” The timing of publication is revealing: the event occurred about 10 years ago, but this particular Sunday was between two judicial hearings about California’s AB 651—one was on June 20; the other will be on June 27. This proposed bill will, if passed, legalize Physician-Assisted Suicide.

Ms. Lamott took a significant legal risk to obtain and to help administer a lethal dose of medication to another human being. These facts could be weaved into a successful criminal prosecution for violating the Drug Enforcement Agency's Controlled Substances Act of 1970, and for manslaughter, which could lead to imprisonment for years.

One of life’s greatest ironies is that when people know that they can determine when they die, they can and often do decide to live longer. Hopefully, Mel experienced more peace and less worry since he knew he had control over when he could die. Had Mel instead voluntarily refused all food and fluid. In this way, he might have "left his uncomfortable earth shoes" a few days later, but Ms. Lamott would have completely avoided taking any legal risk.

While not well known (particularly ten years ago), Voluntary Refusal of Food & Fluid is a peaceful and legal alternative to Physician-Assisted Suicide.

California’s judiciary committee is holding hearings on a proposed bill to legalize physician-assisted suicide. They argue that if patients are terminal and their pain is unbearable, then they should have the option to have their doctor’s help to hasten their lives.

Members of the former Hemlock society used to wear badges carrying this message: “Please let me die like a dog.” Many people have personally witnessed how peaceful euthanasia appears to be. Euthanasia is where the veterinarian injects the animal with a high dose of sedative medication. In contrast, Oregon’s present law, the Death With Dignity Act, and the proposed law in California require the patient to ingest the medications him or herself. Yet the San Francisco Chronicle quoted Dr. Bill Toffler, a co-founder of Physicians for Compassion, a Portland organization made up of doctors who are against assisted suicide, as saying, "In many of the cases, the death lingers for hours. It's not a dignified death. It's not pretty to watch somebody struggle with breathing or having irregular, shallow breathing for hours and hours on end."

Supporters of the California bill point out that the same medications are used, whether taken in a pudding by mouth by residents of Oregon, or injected by veterinarians.

The brother of a man whose brain was badly injured in a car crash is fighting to keep him alive. In some ways the case is similar to when the parents of Terri Schiavo waged their battle, just over a year ago. Doctors say the 31-year-old man will never wake up from his coma so his mother wants to remove his feeding tube after 6 months. By law, that is the mandatory time to wait for patients in the permanent vegetative state. However the brother wants to keep the man alive, arguing that his mother should not be permitted to speak for him since she did not raise either of them. Instead, she dumped them on their material grandparents. Furthermore, the brother noticed that the patient opens his eyes for up to seven minutes, and sometimes does this apparently in response to hearing his name spoken loudly. Doctors don’t seem impressed; instead they emphasize that the patient does NOT move when his skin is pinched. It will be interesting to see whether the Australians stick to their guidelines for timing this decision, or prolong the agony. That happened in the cases of Nancy Cruzan (7 years) and Terri Schiavo (15 years) in the Unites States. Six months will be up in August.

Who should speak for the patient? Will his vegetative state be permanent? Should his feeding tube be continued?

This is a sad case because the person who the law designated to make the decision to end this life is the one who gave birth to that live but then abandoned it. If you want to make sure of who will, and who will not make medical decisions on your behalf if you no longer can, you should create a “Proxy Directive” and list your people preferences.

The kind of brain injury determines how long neurologists wait to decide whether there any potential for recovery of functioning. Mechanically traumatized brains sometimes recover after longer comas than brains deprived of oxygen. The patient briefly described here may be in a Permanent Vegetative State, with no awareness of, or ability to respond to the environment. Such patients as well as those who suffer from irreversible progressive dementia rarely recover, so tube feeding can be considered futile (of no real benefit to the patient).

What’s wrong with the title of this newspaper report?

In mid-June 2006, in Rome, doctors delivered a baby girl by an emergency Cesarean section even though she was two months premature. The reason was that her mother, Cristina, had suffered the rupture of a cerebral aneurysm about three months previously. The machines and medications that were maintaining the functioning of Christina’s organs could no longer keep her blood pressure high enough. For 78 days after being declared brain dead, her body provided the environment for her fetus to continue to develop.

It is sad that the mother died and everyone hopes the baby will do well. At last report, the baby girl weighed only 1.4 pounds, but she was not dependent on machines or medications for the basic functions of life.

What needs a deeper look is the implicit mis-information created by the words that reporter chose for the title of this news article. Take another look, with certain words emphasized:

“Brain-dead woman gives birth, then dies.”

A) Someone who is dead cannot die a second time.
B) Dead people cannot perform any function of life so she did not give birth.

Here’s a more correct way to summarize what happened: After doctors performed a surgical operation to remove a live baby, they ceased providing the technology required to artificially maintain the physiological functioning of the dead mother’s body.

Grim? Perhaps. But accurate. Why worry about it?

Using the wrong words blurs the distinction between biological functioning and personhood. We can only debate what is not clear. For example, the right-to-die versus right-to-choose debate depends on differences of opinion as to when human life begins. President Bush and many others believe that it begins with conception—except in cases of rape and incest, when they do permit abortion. The legislators in South Dakota who passed their state’s HB 1215 in 2006 disagree. They make no exceptions: life begins at conception.

Similarly, at the end of life: Pope John Paul II’s Allocution of March 2004 stated that patients in the permanent vegetative state are still human beings and therefore must be given artificial food and nutrition indefinitely. Many others disagree and believe it is appropriate to discontinue even manually assisted feeding of people in end-stage dementia. These patients are conscious and can experience pain, but no longer can recognize loved ones, communicate, or indicate a choice -- functions that some people consider basic to the definition of person hood.

Certainly one of life’s miracles is the ability of women to give birth. Modern medical technology has the potential to help very premature babies to live full normal lives. Technology can also keep organs alive for a long time, and that will benefit other people. For example, it recently became possible to maintain the physiological functioning of a heart outside the body. Now these organs last longer, making transplantations of donor organs more possible.

In Rome however, doctors did not prolong the functioning of the mother’s organs after the live baby was surgically removed. (Some organs were donated.)

Cases like Christina’s are rare so the news reports them. The last one reported was quite similar: In 2005, Mr. R. Willing entitled his USA Today article, “Brain-dead Virginia woman dies after giving birth.”

The point is that there are tens of thousands of patients who suffer from the permanent vegetative state and a hundred times more than that number who will suffer from end-state dementia. What we decide about when life ends will make enormous social and economic impact on everyone’s lives.

You can decide now, with advance care planning, by writing down your wishes in Living Wills and Proxy Directives. But first you must think correctly; and to do that, you must use the correct words.