Brazen New World
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Brazen New World

Brazen New World

Ending a human life is not a medical decision, it's a moral one.

by

Asked by The New York Times in 2005 what today-taken-for-granted idea or value he thinks may disappear in the next 35 years, Professor Peter Singer, the Professor of Bioethics at Princeton University's Center for Human Values, responded: "the traditional view of the sanctity of human life." It will, he explained, "collapse under pressure from scientific, technological and demographic developments."

This past January 30, the College of Physicians and Surgeons of Manitoba, Canada issued a policy statement that may come to permit the professor to add "prophet" to his curriculum vitae.

In that document, the governing body of the Canadian province's medical profession directs that doctors have the final say with regard to ending life-sustaining treatment of patients – regardless of the wishes or religious beliefs of the patients or their families. It also establishes a baseline for justifying life-sustaining treatment – including a patient's ability to "experience his/her own existence" – below which a doctor is directed to end life-sustaining treatment, regardless of the wishes of the patient's family. The new policy paper has garnered much attention, and may well have ramifications throughout Canada and, conceivably, elsewhere.

Underlying the document – saturating it, actually – is the premise that ending a human life is a medical decision, not a moral one. Or, alternately, that medical training somehow confers the ultimate moral authority to pass judgments on the worthiness of human lives.

 

Doctors, for all their training, are no more inherently qualified to address ethical issues than CEOs or plumbers.

 

Either contention is offensive. A foundation of what has come to be called civilization is that people are not mere things or even animals, that human life has a special, sacred, nature. Historically, the right to take steps to end a life has been regarded first and foremost as an ethical issue, not a medical one. And doctors, for all their training, are no more inherently qualified to address ethical issues than CEOs or plumbers.

As it happens, the Manitoba policy goes beyond the ethical dumbing down of life and death decision-making. It actually betrays a preference for ending patients' lives. For while it gives physicians the final say (even against the family's wishes) for terminating life support, it puts the final decision (literally) in the family's hand when the family feels the patient should die and it is the doctor who feels otherwise. In Manitoba medicine, it seems, death is the desideratum.

That contention is further evident in the Manitoba policy statement's self-awareness baseline, which exemplifies the pitfalls of what might be called iatro-arrogance – or, put more prosaically, medical chutzpah.

Last year, the prestigious journal Science published a report on a young woman who was declared vegetative. For five months, she showed no signs of awareness whatsoever. Scientists, though, decided to put her in a Functional Magnetic Resonance Imaging scanner, a machine that tracks blood flow to different parts of the brain and that was only developed a few years ago. When they asked her to imagine things like playing tennis and walking through her home, the scan lit up with telltale patterns of language, movement and navigation indistinguishable from those produced by the brains of healthy, conscious people. The report's authors, while stressing that the patient may still be classified as "unconscious," conclude nonetheless that she has a "rich mental life."

That young woman seemed entirely unaware of her environment. Only the development of a new diagnostic technology revealed active brain function. Is it unreasonable to wonder what future technologies might yet be developed that will detect other layers of human consciousness? Or what layers might forever elude scientific instrumentation?

And then there is the misguided assumption of medical infallibility. In Calgary last year, doctors were ready to pull the plug on Zongwu Jin, who had suffered a brain injury. After his family obtained a court order to maintain life support, Mr. Jin's condition improved markedly and he is now doing exercises aimed at helping him walk again.

More recently, doctors at Manitoba's own Grace Memorial Hospital sought to disconnect Samuel Golubchuk from the ventilator that was helping him breathe, claiming that he was unconscious and unresponsive – presumably never to recover. Mr. Golubchuk's children, Orthodox Jews whose religious convictions opposed terminating their father's life, promptly sought and obtained a court injunction. The judge in that case recently announced that there were sufficient grounds to doubt the hospital's analysis of the patient's condition, and Mr. Golubchuk's children report that he is now alert and making purposeful movements.

Neither those cases, nor scores of similar ones, seem to have given the Manitoba College of Physicians pause before arrogating to doctors the final say in matters of life and death. One thing is certain: In the wake of Manitoba medicine's new rules, physicians in that province will in the future be spared such embarrassing outcomes. Dead patients tell no tales.

Elephants sometimes do, though, albeit silently. Like the imposing one that lurked in the room where the Manitoba medical group crafted their new policy statement. It was the pachyderm that answers to the name of Professor Singer's polite phrase: "demographic developments."

We live in times when the elderly and diseased are rapidly increasing in number, and where the medical profession has made great strides, increasing longevity and providing cures for many once-fatal illnesses. Add skyrocketing insurance costs and the resultant fiscal crisis in health care, and life runs the risk of becoming less a holy, invaluable divine gift than... a commodity.

And every businessman knows how important it is to efficiently turn over one's stock, clearing out the old to make way for the new. Apparently, doctors can learn that lesson too.

Making things worse still is the great and increasing demand for transplantable organs. A doctor in California currently stands charged with injecting an incapacitated patient with inappropriate medications in order to harvest his organs more quickly. No one knows how often similar things happen – or will happen if society becomes accustomed to allowing doctors to decide when a life is no longer worth living.

 

Judaism considers life precious, indeed holy, even when its "quality" is severely diminished.

 

What does Judaism have to say about all this? Far more than can be summarized in a paragraph or two, to be sure, but certain guiding principles can be briefly stated: Jewish religious law, or halacha, does not always insist that life be maintained; in some cases of seriously ill patients, Judaism forbids intercessions that will prolong suffering. But the active removal of connected life-support systems or withholding of nourishment are another matter entirely. Halacha requires that death be clearly established, and does not permit any action that might hasten the demise of a person in extremis.

Put succinctly: Judaism considers life precious, indeed holy, even when its "quality" is severely diminished.

Quite a different approach from that of the Manitoba College of Physicians and Surgeons. Or from Professor Singer, who has supported the termination of what he calls "miserable beings" – people whose lives he deems devoid of pleasure.

And even as grise an eminence as The New York Times has euphemistically advocated "more humane policies for easing the last days of the terminally ill" – leaving the rubbery phrases "humane policies," "last days" and even "terminally ill" for future clarification.

That may well be, as Professor Singer suggests, the wave of the future. But Judaism was born out of resistance against wrong. Abraham's rejection of paganism was what merited his becoming the forefather of the Jewish people; he was willing, in the words of the Midrash, "to be on one side of the river, while the rest of the world was on the other."

And so, Judaism today finds itself similarly standing opposite a world going mad. Amid the shouts of "Progress!", "Science!" and "Fiscal Responsibility!", Jews who care about their religious tradition must quietly, resolutely, stand the Jewish ground, and say: "No. Even a moment of human life is invaluable."

Copyright 2008 Am Echad Resources

Published: March 1, 2008


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Visitor Comments: 18

(18) Anonymous, March 6, 2008 1:31 PM

"Last year, the prestigious journal Science published a report on a young woman who was declared vegetative. For five months, she showed no signs of awareness whatsoever. Scientists, though, decided to put her in a Functional Magnetic Resonance Imaging scanner, a machine that tracks blood flow to different parts of the brain and that was only developed a few years ago. When they asked her to imagine things like playing tennis and walking through her home, the scan lit up with telltale patterns of language, movement and navigation indistinguishable from those produced by the brains of healthy, conscious people. The report's authors, while stressing that the patient may still be classified as "unconscious," conclude nonetheless that she has a "rich mental life."

This paragraph for me is not an argument against terminating life support systems. In my opinion, this situation optimizes why people should not be kept alive in this manner.

If this woman was truly unconscious, at least keeping her "alive" would not cause her any pain. However, she seems to be aware of what is going on around her. Can you imagine the torture that such a woman must be experiencing every moment of every day trapped in her body without any sort of human interaction, without any possibility of achieving goals or dreams? How do we know that she is not also experiencing excruciating physical pain? Such a fate is far worse than death, and I can't imagine a single person choosing to live this way. I'm sure she does have a "rich mental life-" one rich in vicious nightmares, insanity, indignity, and despair. I don't think anyone would dream of doing such evil to an animal. Why are we willing to do it to a human being?

Life support is not natural. There may come a time when science has the ability to keep someone's heart beating and neurons firing for a thousand years while they sit in a coma, their bodies and spirits destroyed. I wonder, would the author of this article support such a practice if it became available?

Moreover, the suffering of the patient aside, there are economic considerations whether we like it or not. In Canada there is socialized medicine. That means that there is a limited amount of money for the government to spend on health care. Every terminal patient that is kept alive for years in excruciating agony, indignity or unconsciousness, is one less child, mother or father that is able to receive the life saving treatment they need to survive.

I have a deep respect for Judaism and its respect for life. Modern science however has produced machines that can keep people alive in a comatose state for years that would surely have died in any other period of history. To keep people tethered to this earth in a state of torture long after they should have been granted the peace of death is a great sin. This sort of meddling with the will of God does not show a respect for life, it makes a mockery of it.

(17) callie, March 6, 2008 11:25 AM

If I was that woman...

If I was the woman whose brain worked but was stuck in a body that no longer functioned without any means of communication I sincerely hope my family would love me enough to pull the plug. I cannot imagine a worse fate than being a prisoner in my own body. Just lying there all day.... brain on but nothing to stimulate it except silent prayers asking H-sh-m why me? Why her case is used as a reason to keep everyone on ventilators is beyond comprehension.

I agree that the patients' and their families have a say in whether or not life prologing treatment be administered but the doctors need to be listened to as well. While we can think of anectodal evidence in regardss to the few cases where the doctors were wrong what about the many thousands where they are right?

I have heard of parents keeping children who are lifeless puppets on respirators for years. Children who have virtually no brains except for their brain stem... the part that processes pain. And what about Terri Schiavo who after everything was said and done had a brain that was virtually non-existant. Her parents claimed she was alert and responsive... in the end their claims were nothing more than delusions and lies.

I wonder about all the people who die every day b/c medical care has become so insanely expensive that it is out of their reach. No one really mentions that in these discussions. No one mentions the 35 yr old single mother whose cancer was diagnosed too late to save her b/c her company doesn't provide medical insurance (probably b/c insurance is outrageously expensive)

What if we spent the money we use to keep people who will never recover breathing via artifical means and forcing food down their throats wtih tubes on getting preventative care to the people who can be saved? Or are their lives not valuable b/c they are poor or disenfranchised?

(16) Nancy, March 4, 2008 7:41 PM

Decisions need to be ethical and timely

I am a child neurologist, so sometimes need to tell families that their child has a disease with an expected poor outcome. Twenty years ago, families were more likely to choose to avoid ventilators, if they knew there was a good chance that their child would never come back off ventilation. I now have two patients on constant ventilation, portable, who seem to be enjoying life. One child finger spells rapidly and is a good student, the other writes and uses sign language. If life support is to be denied, it seems to make sense for the family and individual to decide before the ventilator is attached, if they want to risk dependence. It is scary to have doctors making decisions to disconnect people who are awake and inter-active, just because they need the bed. The Brave New World is no longer science fiction. I would rather trust my life and death to a rabbi and my family than to an ethics expert. There main role, today, seems to be justifying euthanasia. Chose life.

(15) lzzie, March 4, 2008 5:52 PM

Many seem to misunderstand the Manitoba policy

Many of those who have posted so far seem to misunderstand what is involved with the Manitoba policy and the Golubchuk case. In the Golubchuk case, ICU doctors wish to end the life of a man who is awake, alert, and unable to communicate verbally (apparently due to an old brain injury). They are doing this without the patient requesting it, and against the express wishes of his children. This would be in violation of centuries of Western law and custom related to patient autonomy. People's fundamental right to autonomy precludes someone from harming them, such as killing them. To kill someone who is disabled is still murder.

The Manitoba policy would give doctors the sole authority to end the lives of a patient, without any recourse by the patient or his legal guardians. That too is quite frankly murder.

Read any book on euthanasia policies in the 1930s in Europe. Some of the parallels are shocking.

It is beyond my comprehension how people cannot see this for what it is: a grave threat to the very lives of defenseless, innocent people. Convicts on death row have more rights than those of patients in Manitoba, according to this radical new policy.

I beseech readers to think long and hard whether they wish to have their human rights taken away, by a policy which permits--nay, instructs--doctors to kill disabled patients.

(14) Deborah, March 3, 2008 10:16 PM

misdirected

I was disappointed by this article, and I would have hoped Aish.com would show better judgement in deciding which articles to publicize. As a medical student, I see on a daily basis the catastrophic consequences of futile end-of-life care. To keep an individual on life-support indefinitely is cruel. It is also a waste of precious resources. I do not happen to agree with Peter Singer's utilitarian philosophy of life, but nor do I believe that life should be prolonged simply because we have the technology available to keep someone's heart beating indefinitely. Physicians are not infalliable, but thank gd some of them do have the chutzpah to stand up to families and clergy who want to prolong the pain and suffering of their "loved" ones.

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