Blurring the Line Between Life and Death

Terri Schiavo died on March 31st, a week from today.  Next week will mark the 5 year anniversary of that murderous action/event, indicating a turning point . Next week also begins Holy Week leading to Easter.  It also marks the beginning of Passover, starting Tuesday, March 30th.  It is a good time to consider: Are we to value human life by its utility or because God has have placed His life in us?  Passover is about God delivering His people from Slavery and setting them/us free for Life. Easter celebrates the victory of Life over Death, Christ’s victory. Terri’s death brings both into focus.

Writes Dr. Daniel Eisenberg, M.D. in The Death of Terri Schiavo: An Epilogue:

Blurring the line between life and death, and between medical data and morality, her death signifies a disturbing turning point for American society.

Terri Schiavo did not die of PVS; she died of starvation and dehydration

Terri Schiavo died on March 31, 2005, after lasting 13 days without food or water. Her life and death had a profound impact on the American psyche and brought to the forefront the unresolved debate regarding how we treat severely disabled people and who should be their surrogate decision-makers. There is reason to be disturbed by the role that physicians play in molding public opinion regarding end of life issues, because their expertise is generally in medicine and not ethics.

A letter from a neurologist in complete disagreement with Dr. Eisenberg prompted him to respond:

He (the neurologist) states:

…I find myself in sharp disagreement with Dr. Eisenberg. The article refers to PVS as a “cognitively impaired” condition. In fact, there is no cognition whatsoever in someone who is in a persistent vegetative state. Modern aggressive emergency care developed over the last several decades, has allowed us to resuscitate patients with what would have been terminal hypoxic brain injury (what happened to Terri Schiavo). Unfortunately, the entire brain cortex becomes nonfunctional in these people and we are left with a functioning brainstem that allows for reflex eye movements, facial movements etc. PVS patients can even track a moving object in their field of vision because collicular function of the intact brainstem reflexively guides these eye movements. It is all too easy to imagine sentience in the PVS patient because, as humans, so much of our communication is nonverbal and cued by facial and eye movements.

Dr. Eisenberg responds:

His assessment of the persistent vegetative state is succinct and it is accurate. To the best of our medical understanding, we presume that a person in a persistent vegetative state has no cognition whatsoever. I never gave much credence to those who argued about the rehabilitation potential of Terri Schiavo. Not because I did not believe it to be true (I have no way of knowing), but because it really does not make a difference to outsiders like myself. CT scan results, Glascow Coma Scales, and following balloons are really only of interest to neurologists and family members who need to arrange for the best possible care for the patient.

As a society, what we must concern ourselves with are two questions: What is the significance of being so terribly impaired that there is no cognition and how should such people be treated? It is here that the doctor falls woefully short in his analysis. While I am sure that his credentials are impeccable and his understanding of neurology is excellent, he completely misunderstands the role that physicians should play in society’s evaluation of end of life issues (as we will discuss) and he clearly does not appreciate where medical knowledge ends and morality begins.

Neurologist’s letter continued:

Nevertheless, the activity of our cerebral cortex is what distinguishes our very “humanness”. If the cortex is dead, then the human individual is dead. . . If the cortex is destroyed, personhood ceases. PVS is an abomination of life –in essence a human shaped colony of cells with no sentience — a glorified cell culture. . .Thankfully, I have not seen this irrational preservation of “life” at all costs in this situation since my training in the early 1970’s. . . Patients with PVS and end-stage Alzheimer’s disease routinely have IV’s and feeding tubes removed in the United States every day.

Dr. Eisenberg responds:

The opinions expressed above are very widespread in the medical community today. Variations of these views are espoused by many of the physicians with whom I have discussed this topic. For this reason, they cannot be lightly brushed aside. Please understand that the issue is not autonomy (which is an independent and important issue), but the definition of life. Is the cerebral cortex what makes us human and is it true that “if the cortex is dead, then the human individual is dead”?

Of course not. My physician critic clearly has stepped beyond the bounds of medicine into the realm of philosophy, and that is the problem. As any physician knows, there is neither a state in America nor any sane physician in the world who would declare that someone who is in a persistent vegetative state is dead. If PVS really equals death then why bother pulling the feeding tube? Just bury the patient with the feeding tube still in place! The doctor’s comments are clearly hyperbole, and represent a very insidious type of bias that leads people to equate PVS with death.

People want to feel “good” about the killing they allow whether by deeming a fetus ‘not a real living person’ or a person in a persistent vegetative state ‘as good as dead.’  In matters of morality, the doctor steps beyond the data and expertise of his training to play God.  Dr. Eisenberg asks “why the medical knowledge of the physician seem to translate into skill in evaluating the value of life?”

Dr. Eisenberg reminds us:

“The belief that medicine can determine which lives are worth preserving was an intrinsic part of the pre-Nazi German medical establishment (see “Why Medical Ethics“). In the late 1920’s and early 1930’s:

“a number of prominent German academics and medical professionals were espousing the theory of “unworthy life,” a theory which advanced the notion that some lives were simply not worthy of living. . . If Mengele himself (an infamous physician who performed murderous experiments on live concentration camp inmates) became a cold-blooded monster at the height of his Nazi career, he certainly learned at the feet of some of Germany’s most diabolical minds. As a student Mengele attended the lectures of Dr. Ernst Rudin, who posited not only that there were some lives not worth living, but that doctors had a responsibility to destroy such life and remove it from the general population. His prominent views gained the attention of Hitler himself, and Rudin was drafted to assist in composing the Law for the Protection of Heredity Health, which passed in 1933, the same year that the Nazis took complete control of the German government. This unapologetic Social Darwinist contributed to the Nazi decree that called for the sterilization of those demonstrating the following flaws, lest they reproduce and further contaminate the German gene pool: feeblemindedness; schizophrenia; manic depression; epilepsy; hereditary blindness; deafness; physical deformities; Huntington’s disease; and alcoholism.

I ask again: Are we to value human life by its utility or because God has have placed His life in us?

Read more here.

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