Boinkie's Blog

Universalis

Sunday, May 09, 2004

Nat Hentoff of the Village Voice calls modern medical ethicists “apologists for death”.

They can explain in great detail why a person lacking “consciousness” have a life of no meaning. Then if the person shows signs of consciousness, they insist it it “minimally conscious state” and again explain why these people have “life unworthy of life” and should be deliberately starved to death. Indeed, people like Joseph Fletcher insists that anyone with an IQ under 20 does not meet the “criteria for personhood”, and that people with an IQ under 40 only questionably meets his criteria. And Peter Singer insists that newborn infants also don’t meet his own “criteria for personhood” and therefore parents should have the option for killing them if they are imperfect or merely unwanted.

As a doctor, we face a lot of life and death decisions.

But I worry when the "choice" of death, such as the courts are twisting in the Terri Schiavo case, ignores reality.

http://www.sun-sentinel.com/news/local/southflorida/sfl-56braindamagedwoman,0,4966335.story?coll=sfla-home-headlines

You see, many feeding tubes are placed because they are easier than feeding by mouth a person who has trouble swallowing. Indeed, if a person is unable to swallow, the average life span is 6 months. You see, if you can’t swallow food, you also can’t swallow saliva, so you die of aspiration pneumonia.

Using a feeding tube for someone with terminal Alzheimer’s doesn’t really extend their life: It merely makes their deaths more comfortable, since good nutrition prevents bedsores. Nevertheless, I’ve advised against feeding tubes for people with Alzheimers’ disease, or after a severe stroke, and advised families against artificial hydration in people with terminal cancer or those whose organs were badly damaged and were dying of other diseases. Such treatment is futile, and only prolongs the dying process.

Now, the most radical religion in the pro life arena is probably the Catholic religion. And Catholic law allows even normal people to refuse “extraordinary” treatment, including feeding tubes, major surgery, and amputation of limbs. We make this decision with prayer and judgement, each case needing individual discernment. In Africa, if a trip 300 miles to a university hospital meant you might live, but would bankrupt the family, it was considered ethical to stay home.


But it is something else entirely to argue that mentally disabled people should be starved because their lives are meaningless.

Mother Teresa and her sisters once risked their lives rescuing profoundly retarded children who were caught in the crossfire of the Lebanese Civil war.

The doctors in Hitler’s T4 program saw these children as useless eaters, and saw their deaths as a good thing.

How we treat our elderly, our sick, and our disabled brethren depends greatly whether or not we see them as “useless eaters” or as our brothers and sisters.

One of my native American patients suffered a stroke. She was paralyzed, but alert, and had the emotionality that we see in people with frontal lobe damage. So we sent her with relatives to the big city to see a neurologist to see which psychotrophic medication would make her more comfortable without making her half asleep.

Instead, he spent an hour arguing with her family on why they should remove her feeding tube and "let her die". She wasn't in vegetative state, but that didn't matter to him. He only saw a useless person who would cost the family money.

The family finally walked out; their comments to me was: well, we Indians aren't like you white people. We respect our elderly. They still had the idea that the Lord gave each of us a path to follow, and that her path was to be cared for, and their path was to lovingly care for her despite her handicap.