America’s growing fascination with what constitutes a living, breathing human being is a constant amazement to me. This idea was brought up again in the New York Times last month. Entitled “When does death start?,” the article by Darshak Sanghavi provides a lesson in how easy it has become for man to dismiss acts of terror as simple practices involving medical decisions to end a human being’s life.
Using the real-life experiences that followed a tragic accident rendering a fifteen-year-old girl named Amanda nearly dead, Sanghavi involves the reader in the emotions this young girl’s mother was experiencing. Having hooked the reader into sympathizing with the mother, he carefully turns the corner and addresses different ways of donating organs once a patient is subjectively defined as nearly dead.
In Amanda’s case, there was a challenge to the treating physician. Upon examination of the child, whose own reflexes indicated that her brainstem was still working, Dr. Monica Kleinman decided that she could not pronounce the child brain dead. Clearly, the organs could not be taken from a patient who did not meet the brain death criteria. But there were other ways of getting those organs and the doctor understood what they were:
To diagnose brain death, doctors typically go through a checklist of about a dozen items, including assessing reflexes like blinking, coughing and breathing, which are all controlled by the brainstem. The criteria are extremely strict, and only a tiny fraction of severely brain-injured people meet them. Kleinman realized that Amanda, despite her severe brain damage, was not one of them. There was, Kleinman told Beaulieu, another option — one that was still controversial and had never been pursued successfully at Children’s Hospital. The procedure was called donation after cardiac death, or D.C.D., and it would exploit the other way the law defines death: as the “irreversible cessation” of the heartbeat.
Before delving into this matter, that involves the desire among some physicians, ethicists and others with a vested interest to redefine death in such a way as to provide the most bang for the buck in the organ donation business, one thing must be made perfectly clear. Amanda was severely brain damaged, she was not terminally ill, she was not at death’s door, she was inconveniently clinging to life as far as the organ vultures were concerned.
Once a decision is made to get the organs, the alternatives are readily at hand. To further justify the taking Amanda’s organs, and the possibility of countless others in similar condition, Sanghavi reports,
With modern technology like respirators and tube feedings with synthetic formulas, [Amanda’s mother] Beaulieu might have kept her unconscious, brain-damaged child alive indefinitely. But as she sipped coffee in her apartment from a mug reading “#1 Mom,” Beaulieu told me that if Amanda had lived, she could “never bike, rollerblade or go out with friends, and she’d never want that.” If people with no hope for meaningful recovery can be kept alive artificially, shouldn’t they also be permitted to die artificially?
And therein lies the rub. The subjective judgment of an agonizing mother reinforced by a medical team was all that was required. Once everyone was in agreement, taking the organs commenced without a hitch.
If one studies the entire history of man’s efforts to redefine what it means to be dead, starting with the Harvard Criteria of 1968, it is all too clear that medical ethicists, bioethicists and clinicians have been attempting to serve the growing needs of the organ transplant advocates for years. They continue to do all they can to expand the definition of death in a way that, one assumes, will relieve the anguish of a family whose loved one is in a bad situation while helping someone else to live longer. It is perceived to be a very noble idea, but it is anything but.
As Paul Byrne, M.D. points out:
In medicine we protect, preserve, and prolong life and postpone death . . . Our goal is to keep body and soul united. When a vital organ ceases to function, death can result. On the other hand, medical intervention can sometimes restore the function of the damaged organ, or medical devices (such as pacemakers and heart-lung machines) can preserve life. The observation of a cessation of functioning of the brain or some other organ of the body does not in itself indicate destruction of even that organ, much less death of the person.
But the slippery slope keeps sliding, paying little to no heed to Byrnes and others like him who understand that a human being is alive until he dies, not until someone hastens his death by whatever means appears to be appropriate.
Practicing nurse and medical ethics writer Nancy Valko has had a great deal of experience with patients like Amanda and with the subject of non-heart-beating organ donation, or NHBD. She writes,
In cases of severe head injuries, strokes or other critical conditions that can qualify a patient for NHBD, it is virtually impossible at the beginning to accurately predict whether the patient will die or what level of recovery he or she may eventually attain. As a nurse for 34 years, I have personally seen many such patients, who initially needed a ventilator and who were even expected to die, go on to completely recover.
However, for those who advocate the subjective art of deciding who should live and who should die based on a sliding scale of what it means to be a human being, the redefinition necessary to excuse some people from living is not a problem. And if enough concur in such a view, and a consensus is created, then no one need feel guilty about the matter.
Sadly, in addition to cases like Amanda, we have another focus of attention, as Wesley J. Smith pointed out recently regarding the subject of “palliative sedation” (a nice set of words for early imposed death):
A hospice nurse correctly points out that PS [palliative sedation] is a rarely needed last resort:
Too often, palliative sedation is used as a first-line therapy rather than a therapy of last resort. In some units, palliative sedation is used on one-third to one-half of patients. That is far too often. Most expert providers will use palliative sedation extremely rarely in a 20- to 25-year career. Further, expert providers do not use palliative sedation lightly. They consult with colleagues to make sure that all other means of symptom management have been tried.
But when cost cutting is high on the agenda, and there are too few beds in a critical care unit, a consensus can provide the protection needed to intentionally sedate a patient to death. And who’s going to ask questions, call for an inquiry or otherwise discuss the possibility that a crime might have been committed?
Clearly, health care doesn’t always mean what we think it means. That’s the bottomline when discussing what it means to die in America today.
The most disturbing aspect of all this recent reporting on brain death, non-heart-beating death, palliative sedation and terminal sedation is not that it is happening, but that those who are its staunchest advocates apparently have no pangs of conscience about what they are literally imposing on the vulnerable. It is as if any thought of sinful acts simply isn’t entering the minds of such people.
That is the core problem with pro-death advocacy. There is no guilt experienced for having committed a wrong because in their world there is no right or wrong, only opinions that sometimes are in disagreement. Sadly, the idea of feeling guilt for having done something as horrendous as killing another person or arguing in favor of doing so is not even a consideration.
But wait! The Catechism of the Catholic Church tells us: “Conscience can remain in ignorance or make erroneous judgments. Such ignorance and errors are not always free of guilt.”
And Cardinal Joseph Ratzinger, now Pope Benedict XVI, expanded on this teaching in a speech entitled “Conscience and Truth.” Quoting psychologist Albert Gorres, he reminds us:
Whoever is no longer capable of perceiving guilt is spiritually ill, a "living corpse, a dramatic character's mask," as Gorres says. "Monsters, among other brutes, are the ones without guilt feelings. Perhaps Hitler did not have any, or Himmler, or Stalin. Maybe Mafia bosses do not have any guilt feelings either, or maybe their remains are just well hidden in the cellar. Even aborted guilt feelings ... All men need guilt feelings."
If there is an antidote to the escalating trend to kill those perceived to be inconvenient, unwanted or otherwise expendable, it is guilt because without it, man can perpetrate any horror you can think of and the acts committed will soon become commonplace practice. Clearly, terrorism comes in many forms—not the least of which is direct killing of the vulnerable.