To Live Or Not Live

Much has been written-TV-radio-talked-viewed to extremes ad nauseam with regard to the Terri Schiavo matter, but little seems to have been said about measures that can be taken to guard against the circumstances surrounding this tragedy, although there has been a good deal of opinion and fact expressed with regard to the need for everyone to complete and legally effect a Living Will, which might more accurately be defined as a “Dying Will.” This instrument may or may not be followed by one’s survivors, but it will at least take the monkey off their backs if they are disposed to give it credence, never mind the legality angle. Indeed, it is noble of one to care enough about his/her relatives to spare them the possibility of both agonizing over a painful decision and then having to live with it, possibly suffering emotional distress over a long period, even a lifetime.

It’s obvious that patients can’t live for a long period on machines such as respirators, thus the decision to “pull the plug,” though terribly painful, can at least logically be made concerning even those who are not brain dead…who may actually be quite alert but hopelessly, terminally ill and direct that the end be allowed to happen, the sooner the better in behalf of not only escaping the personal misery, but delivering loved ones from the onus of both grief accruing to a terminal decision and a perhaps untenable predicament with regard to keeping the patient alive. How, for instance, can a 100-pound woman take proper care of a bedfast, vegetative 250-pound husband?

The term “extraordinary means” does not mean the same thing to all people. While a respirator may be rather universally acknowledged as extraordinary, and therefore susceptible to removal leading to death, a feeding tube inserted into either the nose or stomach is acknowledged by, for instance, the Catholic Church, as ordinary and therefore an acceptable, if not necessary, treatment for keeping one alive, notwithstanding that this could mean many years in what amounts to a vegetative state, that which the experts ascribe to Mrs. Schiavo, who has experienced 15 long years of such a state. Therein lies the point at which the rubber hits the road. The question: Since both air and food/water are necessary to sustain life, is there any difference between them with respect to being accounted as extraordinary or ordinary in their introduction and maintenance?

Ironically, at just the time a feeding tube has been withdrawn from Mrs. Schiavo, the doctors are considering placing a feeding tube in Pope John Paul, who has been in and out of the hospital lately, cannot talk or walk, and cannot feed himself. Also, a tube has been inserted into his trachea to help him breathe; however, he is rational, whereas Mrs. Schiavo has been virtually comatose for 15 years, unable to do anything for herself, and, according to the doctors, totally unaware of everything.

One solution with respect to someone in Mrs. Schiavo’s initial condition might be to simply not insert the feeding tube, in the first place. She was probably sustained by use of intravenous methods in the beginning of her ordeal while it was being determined, if possible, what her status would become. That’s perfectly reasonable. Not long ago, a relative was faced with the decision, after his 81-year-old mother had suffered a massive stroke and was unable to eat, communicate, or do anything for herself (also seeming not to recognize anyone), and upon the verdict of the physicians that she would get no better, of either having a feeding tube inserted, allowing her to vegetate in a nursing home experiencing dreadful bedsores and myriad other afflictions, or letting nature take its course, as it had for millennia before the introduction of extraordinary means, including, at least in this corner, the feeding tube. He decided to let nature take its course.

A number of years ago, a 91-year-old relative suffered a brain hemorrhage so massive that the blood ran down inside her spinal cord, and the doctor said she had 24 hours to live. She lived beyond that time, and the doctor said 48 hours. She lived and continued to exist in a stabilized coma (if there is such a thing), unaware of anything, unable even to be awake, not to mention know anything or anybody. She was kept alive in the hospital intravenously but could not stay there. The decision was made to withdraw the I-V, and she lived for 12 more days before experiencing a painless death. There was no feeding tube. If there had been, her body, though old, was strong enough to probably exist for years. She had no Living Will, so the decision had to be made by her closest relatives, not an easy thing.

So…there’s Mrs. Schiavo, the two relatives, and the pope. For all practical purposes, the three former individuals have/had bodies but no minds. The pope has a mind but no actually functioning body. Would it be reasonable to say that a person without a mind is actually not alive, or is actually not experiencing life, the primary definition of which is “the quality that distinguishes a vital and functional being from a dead body” (Merriam-Webster’s Eleventh)? The three former are/were not functional beings and can/could not be acclaimed as vital, since they serve/served no useful purpose either to themselves or to their society. This sounds harsh, but it isn’t intended that way…it simply states a fact. The pope, on the other hand is at present possessed of a mind, serves as head of the church, and is susceptible of healing, though such is a long-shot. If he passes into a permanent mindless state, the “body but no mind” concept could apply.

It may be that the words of Paul the Apostle are instructive as found in the first sentence of Romans 12:2. “Do not conform any longer to the pattern of this world, but be transformed by the renewing of your mind” (NIV). Though he was certainly a spiritual leader, Paul, at least in this instance, was eschewing emotion (the drive to conform), either passive or direct, in favor of intellect as the motivating force behind a being’s actions/existence. When intellect is gone and thus the ability to use the mind and govern the body, should a relative, absent a Living Will, actually perform a useful service in making the decision to “pull the plug?”

There are no answers here…only more questions. Everyone has to make up her/his mind, but, hopefully, these suggestions/reminders will provoke thought. Using the definition of life as a marker, would this admittedly feeble paraphrase of a part of a famous monologue be appropriate?

To Not Be

To not be, or not to not be: that is the question:
Whether ’tis cowardly in the soul to forego
The vicissitudes of gross disappointments,
Or to retreat from one’s trials and troubles,
And by retreating feed them? To live: to breathe;
Again; and by a life to say we stand
The heartache and the thousand natural shocks
That flesh is heir to, ’tis a certain battle
Normally to be feared. To live, to breathe;
To live: perchance to win: ay there’s the clue;
For in that life of trial what wins may come
When we have bruised this mortal coil,
Must give us hope.

(apologies to the bard)