March, 1980 I/7
WHOSE LIFE IS IT ANYWAY?
During the past year, a Broadway play entitled, Whose Life Is It Anyway? (1) by Brian Clark, has portrayed dramatically the problem of what type of care to give people who may be kept alive in a conscious state but whose level of human activity would be impaired drastically. This problem is solved rather easily when the person in question is rather old, in an irreversible coma and near death from natural causes. Then there is little question that life supporting means may be removed and "nature allowed to take its course." But when the person concerned is conscious and states that he or she does not wish to live an impaired life with mechanical support systems, what judgment should be made? "Whose Life Is It Anyway?" offers a means to consider this problem.
Ken Harrison is a young sculptor who had a very serious automobile accident. Six months after the accident, he is still in the hospital and "as a result of treatment, all the broken bones and ruptured tissues have healed and all that remains is the ruptured spinal column and the mental trauma" Because he will be paralyzed for the rest of his life, unable to urinate or care for himself in anyway, Ken decides that he does not wish to go on living. When informed by a social worker of the things he will be able to do "with training and a little patience," such as operate a typewriter and reading machines, he replies that this "would not be good enough." When discussing the situation with his lawyer, Ken states that though he realizes other people may live with dire handicaps, for him, life would be too burdensome if he were to continue in this way. Ken, then, wishes to be discharged from the hospital, have the catheter removed, so that "the toxic substances will build up in the bloodstream and poison him."
Dr. Emerson, the attending physician, believes that Ken is merely depressed and that if given more time will choose to live. He states, "It is impossible to injure the body to the extent that Mr. Harrison had and not affect the mind." From his experience, he thinks that Ken will change his mind later on. In order to prevent Ken's discharge and ensuing death, Dr. Emerson seeks to have Ken committed to the hospital as mentally unstable, but Ken's lawyers apply for a writ of habeas corpus which would free Ken to leave the hospital and discontinue the lifesaving care. The climax of the play is the hearing on the writ of habeas corpus, Justice Millhouse presiding.
Do you think that Ken has the moral right to choose death in this situation? Is he committing suicide? For solving this problem, ethicists use the principle of ordinary and extraordinary means. If the catheter is judged to be an extraordinary means, then it may be removed and thus Ken would be allowed to die. From an ethical point of view, a surgical procedure, medical device, or medicine cannot be determined as ordinary or extraordinary until we know the condition of the patient and whether or not prolonging his life will help the person attain the goal of life. Ordinary means then are those that do not involve a grave burden for oneself or another, judged according to the circumstances of persons, places, times and cultures; extraordinary means do involve a grave burden. Another means of determining whether means are ordinary or extraordinary is to ask, "will prolonging life through this means present an intolerable burden to the patient," or "Will prolonging life make it too difficult to achieve the goal of life?"
The reason why we can make the distinction between ordinary and extraordinary means from an ethical point of view is because human life is not the greatest good, nor the greatest value. Life, health, all temporary activities are subordinated to spiritual ends. True, human life is a very important gift which we should protect and foster. There is a duty toward God, as well as other people, to protect our life and health. But in some cases, protecting or prolonging human life may not contribute to achieving that more important good, the purpose of human life. People may differ in defining the purpose of human life. Some may describe it as sapient life, others as the potential to relate to others, and others as spiritual growth and development. But all seem to agree when the purpose can no longer be achieved, then the duty to prolong life is no longer present. That is why a respirator may be judged as an extraordinary means for a person in an irreversible coma, and that is why a person with a terminal illness may determine that trying to cure the illness is worse than dying now. In Ken's case, it seems he is saying that the pain and suffering associated with his disabilities make it too burdensome for him to prolong life. In effect, he is saying, "Insofar as achieving the goal of life is concerned, it would be less burdensome to let me die now than to prolong the pain and suffering through such medical means as a catheter."
The Last Act
To find out what Justice Millhouse, Dr. Emerson and Ken finally decide, see or read the play. All in all, I do not think that Ken is asking to commit suicide; rather he is asking to be allowed to die. But I agree with Dr. Emerson that Ken should have some time to think over the situation and experience the type of life he would be able to lead as an invalid before he wishes to have the catheter removed. Life is sweet and not many people really wish to die. In this regard, a physician stated recently:
"Talk about a 'dignified death' usually comes from onlookers, not from the patient. Most patients want to live..... Dignity lies in their fight for life and in their struggle to maintain contact with humanity. Kindness, personal attention, and good nursing help to preserve a patient's dignity." (2)
Kevin O'Rourke, OP
1. The Dramatic Publishing Company, Chicago, 1974.
2. Dr. H. Epstein, Arch. Inter. Med., Aug. 1979, p.919.
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