*******

What is terrifying oblivion to one person might be a release into a new life of another. These two visions represent two very different views of death. To the materialist, death is nothingness, infinite, dark cessation. To the spiritual being, it is a promise of bright new beginnings, not only the "reshuffling" of the cosmic "deck," but an entirely new "game."

We must all make choices, often critical ones, that involve our personal lives and deaths. The old standards that have guided the Western world for a couple of thousand years are starting seriously to unravel. That is, the idea that life can be simply quantified, so that "more is better," and so that the only goal of medicine is to prolong biological function, is beginning to give way to an ethic of quality, in which the goal is to make life as enjoyable and comfortable as possible.

In 1993, in Britain, for example, it was ruled that doctors were legally allowed to end the life of a man for whom they had cared, partly because the quality of his life had been irretrievably lost. In that same year, the practice of euthanasia-- ending a person's life deliberately in order to avoid a life of horrors-- was legalized in the Netherlands. In 1994, a US doctor was acquitted of charges when ha helped a man commit suicide. This indicated some social approval of physician-assisted suicide, under certain conditions.

Right now, we are all caught up in a transition between the value of life seen as "quantity" and that seen as "quality." Even the highly conservative AMA has started to see how futile it is to maintain a person's biological functions for ten to thirty years when there is no hope of recovery. At the same time, however, they still insist that it is wrong actively to take a life. But, in emergency rooms all over the world, traditional ethical systems have become an odd combination of farce and tragedy. Conservatives still mouth phrases about the "equal value of all life," regardless of human conditions. This attitude has given rise to a medical establishment whose sole goal is the prolongation of biofunctions, regardless of the absence of any quality, productivity, satisfaction, or even consciousness in a given case.

Home · Products · Affiliates · Search

Now, medical technologies have made it imperative to begin to change the old ethical standards. For human beings are now capable of maintaining indefinitely the bioprocesses (respiration, circulation, etc.) long after all consciousness has been irretrievably lost. A great window of opportunity now presents itself for all of us to begin to embrace a more reasonable, more compassionate ethical standard.

This new ethical perspective is less arbitrary, and more responsive to what people choose for themselves, and avoids the mechanical prolongation of mindless life as an unmitigated good.

It also has economic ramifications. In an age of increasingly scarce medical supplies, is it wise, just, or compassionate to spend $150,000 yearly for ten years or more to maintain the body of a man whose consciousness is irreversibly obliterated due to a horrible injury to the cortex of his brain?

In Germany, a brain-dead woman was pregnant, and the doctors went against the wishes of her family by insisting that her biofunctions continue to be maintained artificially by machines. The public was outraged, and there was talk of "women as incubators."

Two spiritual questions are relevant here: When did the soul leave the body of the mother? And when does the soul enter the body of a new infant? If traditional spiritual views are heard, it would be said that the woman's soul had already left, and the baby's permanent soul had not yet "locked" into the physical body.

Some would argue that to shut off the machines would be simply allowing nature to take its course, and that to keep the woman connected would constitute a kind of artificial interference. Others, however, would claim that to turn off the machines would constitute murder. The basic question is one of perception: How do you treat someone whose brain is dead, but whose body is still warm and breathing? If life is seen as a largely biological process, then deactivating would be murder; but if life is seen as a spiritual and soul-process, then the essence of the woman would be seen to have already left behind that body. Thus, much of the old ethics arises directly from the reductionistic picture of human beings as simply animals or mechanisms, and so the preservation of bioprocesses becomes the supreme, indeed the only, good or goal of medicine.

The question, in realistic terms, is even more complex: For often, in order to keep one body alive, other, conscious , active, productive, conscious beings must suffer loss, or even death. Can resources reasonably be allocated this way?

New ethical standards also demand recognition that some lives are worth more than others. An active, kind, loving, productive, sharing, communicating life is obviously intrinsically better than a life spent in a "consistent vegetative state."

Doctors used to say that death occurred only when breathing and circulation ceased. Then, they later said that death occurred when the entire brain was dead. Finally, that was replaced by the more realistic and practical view that death had occurred whenever the cortex (the thinking, conscious aspect of the physical brain) was deactivated irreversibly.

Again, the practical reality is a bit more complex than the abstract: For in 1967, with the beginning of heart-transplantation, the need for human organs began to increase. Thus, the heart could be used either to sustain mechanical but unconscious, insentient life, or else it could be used to support a life capable of joy, love, and human interaction and social contribution. But it obviously could not be used for both simultaneously. For some patients in deep coma threatened to remain in that unconscious state for many years.

The paradox was that, for all practical purposes, a person who could never be revived was already dead; but, if she were still breathing, the definition of "death" would have to be restructured. Also, the use of respirators to keep permanently unconscious patients breathing was posing a major problem regarding the allocation of limited resources. Besides, those in irreversible comas became new sources of potential organs to help save the lives of active, conscious beings. Could it be moral to ignore these needs in favor of the old "line" about the intrinsic and unqualified sacredness of bioprocesses?

Thus a brain-death committee from Harvard defined death in terms of the brain-function, rather than body-function. So, many on respirators were already dead, but not recognized as dead by antiquated, old-style legal systems.

The church had always defined death in vague terms as the final, irreversible separation of soul from body. If this is to have any validity, or even any relevance, the point at which this occurs must be determined. Present instrumentation is so crude that there is currently no hope of developing any kind of sensor that can detect such a subtle event. But perhaps the human brain is this kind of sensor.

Since cortical deactivation in an irreversible way is a criterion of death, there arise other questions: For example, some babies are born anencephalic, or without a brain at all. Are they to be regarded as living? How many limited resources are to be used to maintain their bioprocesses? Still others are born normally, but suffer early and catastrophic brain-injury to the cortex, making consciousness and responsivity impossible. They will never gain or regain, consciousness.

The story is told of two children, one of whom had a catastrophic bleed into the brain, resulting in irreversible unconsciousness; the second child badly and immediately needed a heart, and the child who was cortically dead had a good heart; yet it was considered illegal for a transplant to occur. Was the loss of both children worth the defense of an old system that insists on the inviolability of biological life?

Since death is a process, not a moment, the moment of death must be selected or chosen; it cannot be "discovered." It might most clearly be defined as the irreversible loss of the capacity for consciousness, according to new, reasonable, compassionate, and spiritual standards.

Also, through new techniques in angiography and tomography, it is now possible to tell exactly through which structures of the brain the blood is still flowing, and thus the deactivation of the cerebral cortex can be pinpointed with accuracy. So, if blood is not flowing to the cortex, even though the patient might not be brain-dead, she is cortically dead. We can be sure that consciousness-capacity has been irreversibly lost.

In bioethics, morality, and compassion , what is loved is a conscious being, not just a body. The body is the "container" or wrappings of the sacred; it is the tool of the sacred mind. It is not itself intrinsically sacred, unless made so by the indwelling spirit and soul. Thus, when cortical death is present and irreversible, attempts to sustain biological life are no longer obligatory.

For the idea of life as sacred cannot possibly be detached from the idea that the person is sacred. It is not breathing or circulation that is sacred, but the mind or soul interlaced with and supported by these processes. This is why brainstem-function and mechanical support of bioprocesses cannot be taken for "life."

One can imagine the nightmare of a hospital filled with "living" but permanently unconscious beings. Do not living beings also have the right to die with dignity, indeed, to choose death if they have a clear sound mind? And when their brains have ceased conscious function, should they not have the right to leave this world in as painless and dignified a manner as possible?

Also, although economic consideration s should never be the sole, or even the major, criterion, for making these crucial decisions, the truth is that it costs well over ten thousand dollars a month to maintain a person in a persistent vegetative state in which consciousness is completely absent. This is not only wasteful to care-givers, but is also terribly, unutterably, horribly humiliating to the one being "serviced."

When a being has become permanently insensate, with no cognitive ability and insentient, death itself becomes a matter of complete indifference to the one being tortured by the well-intentioned champions of a purely biological life-continuity.

British law now states that, for life to be of any benefit, the person must have some awareness, or consciousness, of being alive. This is contrary to the old views of medical intentions, to maintain body-functions at all costs, regardless of quality or consequences.

At times, the removal of sustenance might be enough to allow an insensate person to follow a natural pattern of a dignified, painless, timely death. A good, wise doctor is fully justified in doing anything that he/she can to ease suffering, even if that action shortens biological life-span. For to foresee the shortening of life is not the same as to intend the shortening of life. For in the end, it is the intention that might mark the real difference between murder and sound compassionate medical practice.

Another crucial question that must be addressed if the patient has any consciousness is, Does the treatment designed to maintain life create pain? If it does, then its termination might be deemed desirable even if some form of consciousness is present. For many would actually prefer the cessation of life entirely to a life filled with pain. And, of course, if cortical death has occurred, the person feels nothing.

In US law, there is a right to privacy that allows for a family to "unplug" if consciousness is deemed to be irretrievably absent. In this, the legal system appears to have moved beyond the old "quantity" value-system.

Thus, under extraordinary conditions, it can be not only right but obligatory for the moral person to act deliberately to take an innocent human life. Technological advances have simply made it impossible to take an unyielding stance "set in concrete" on this matter.

These rulings and ideas do not open wide the door to euthanasia, for they make a clear distinction between allowing a natural death on the one hand, and on the other, taking an active, initiative, positive step to end a life. Passive euthanasia is legal, but active euthanasia is not.

ABORTION AND FETAL LIFE.

Society permits the abortion of the fetus up to twenty-four and one-half weeks, but if a fetus is born before that time, every effort is strained to insure survival.

Anti-abortionists often prefer the name "pro-lifers." But this is a serious misnomer and error, for it implies that those who are pro-choice are actually "anti-life." Also, since "pro-lifers" support war and capital punishment, this does not cover the entire spectrum of their philosophy.

From a spiritual perspective, Jesus did not even mention abortion; the scholar Thomas Aquinas felt that the fetus was "unformed" until the soul entered it. The condemnation of abortion from the time of conception as a mortal sin is a relatively new teaching of the church. The church has even held to the violent, extremist position that even if the birth of the fetus will kill the mother, it must not be aborted.

In the 1850's in the US, abortion was made illegal. The AMA lobbied Congress for laws against abortion. By the turn of the century, every state had laws prohibiting the practice. This lasted until the fifties, when the use of the drug thalidomide created a demand for the return of abortion-rights.

This was never a black-and-white decision of life versus death; the quality of life of the child was always a factor, and so was the quality of the mother's life. Most laws, for example, permit abortion when the child threatens to be seriously deformed, in most countries. Most abortions, contrary to common belief, are not sought by teen-agers, but by mature women. Abortions might have increased as technology made it possible to detect before birth certain extremely serious handicaps and deformities. Between 75-78% of people interviewed say that the woman should have the right to an abortion if the fetus is deformed. This has indicated a general shift away from the "quantity" evaluation of life to the "quality" perspective.

Also, embryos can now be produced in vitro, that is, outside the human body. And contrary to those who want simple answers, there is no clear "moment" of conception. It is instead a process that lasts about twenty-four hours. Even after the sperm has entered the egg, the two do not immediately join their genetic materials; this happens only about twenty-two hours later, in a process called "syngamy." Experiments with human eggs have been permitted up to, but not including, the point of syngamy.

A new and relevant factor to birth is the exploding population of the world, which is growing beyond any capability-- ecological, economic, or political-- to support the massive population. A population of eight billion in predicted by 2015. Some say that to dispose of an egg that has been entered by a sperm is the same as disposing of a human life. This is because the structure has the potential of becoming a human being. But, carried to its most logical extension, this same argument could be applied to either sperm- or egg-cells alone, each of which could become a human being under the proper circumstances. Would it be "wrong" to dispose of sperm and eggs because they could become human beings?

Once a sperm and egg have united in the womb, in nature, the chances of the embryo's growing into a complete human being are only about thirty percent. Thus, it is absurd to try to define a precise moment when a "human being" comes into existence.

Some argue that the point of "viability"-- that is, when the fetus can survive outside the womb-- marks the point when a fetus is a "real" human being. But a fetus can survive outside in a well-equipped hospital, but not in a jungle. So, is "humanness" really dependent on environment?

As technology progresses, the point of viability moves back towards the time of conception; it is now estimated to be about twenty-two weeks. So, it can be seen that the argument of viability is a relative and insubstantial one.

Further, with the development of "ectogenesis," it is possible that an embryo might be brought to full term without ever having entered a human womb.

Many are now turning from this poor argument, and saying that the beginning of brain-function within the fetus is actually the point where it becomes truly "human." (This is about ten weeks.) This idea of "brain-life" has a nice symmetry with "brain-death," considered to be the end of viable life. Specifically, the development of activity with the cortex marks the beginning of a viable independent being capable of consciousness. The tenth week after conception, "neuroneuronal integration" begins in the cortex of the fetus.

Again, the facts that a being is both human and alive cannot alone serve as the sole criteria of an automatic necessity to continue that life. Ronald Reagan pointed out in 1983 that we must choose between the traditional "sanctity of life ethic" and the "quality of life ethic," and, when the pressure was on, his administration actually supported the "quality" perspective. For, in the famous "Baby Doe" case, a baby was born with Down's syndrome, a condition formerly known as "mongolism." But he also had an improperly formed esophagus, and his life could be saved only by an operation. It was suggested by the doctor in charge that the baby be kept in the hospital and be maintained in a pain-free state, but allowed to die-- in other words, that he not receive the operation. His parents concurred. The court ordered this, but after the baby died, the public grew hostile. After this, the Reagan administration made it a federal law that handicapped persons were not to be discriminated against, especially if they were infants. In one case, this led to the expenditure of $400,000 on an infant whose survival probability was rated at "zero." Custody was ripped away from parents who refused surgery. The government even established "baby Doe" squads, which ransacked hospital records and otherwise violently took control of some infant-care cases. Before long, professionals had to go to court to get the laws struck down. Even the conservative C. Everett Coop came down on the "quality of life" side of the argument. The "baby Doe" laws were finally struck down. In 1983, it was ruled that the law does not require the imposition of "futile therapies" which only "temporarily" increase the life-span of an infant.

The Supreme Court ha s also found that severe prematurely or multiple handicaps can be used as a grounds for non-treatment. Treatment of infants in irreversible coma, or treatments that only prolonged the dying process, were decreed unnecessary.

In August 1988, a seven-month-old infant swallowed a balloon; his brain was without oxygen for quite some time. He lapsed into an unchanging coma-state for eight months. The family asked for his respirator to be turned off. The hospital refused, and his desperate father unplugged it. After the hospital stubbornly reconnected it, the distressed father returned with a 357 magnum, and unplugged the device. Holding his baby dying in his arms, he sobbed until the child's life was gone. Then he tearfully turned himself in to the police. Although he was charged with murder, the grand jury refused to indict. Most people approved of his cause. Finally, it was legally ruled that the child had actually "died" at the time that he had swallowed the balloon.

Some babies are born with a terrible condition called "spinabifida," which completely paralyzes legs and creates loss of control of bladder and bowels. Intellectual disability is also usually present. Some children were not helped even by thirty or forty operations. More than eighty-three percent were still severely challenged even after full treatments. One of the doctors who pioneered this treatment came to the conclusion that certain severe cases should be left untreated, even if that resulted in death. He did think that they should be kept free of pain, until they died, usually within six months. The medical "pendulum" began to swing away from universal intervention, and some argued that it was only allowing nature to take its course. The Department of Health and Social Security in Britain endorsed selective non-treatment.

Those who are angered by the new shift in the medical paradigm often take a naive and simplistic view of life, even idealizing it. They argue that life is always good; this is simply not at all the case. Life can be a living nightmare, a hell, for some; and, for them, death can be a preferable state.

Also, those who often argue the most loudly for the unqualified preservation of life at all costs are often Christians, or other religious people who claim belief in an afterlife, or in immortality of the soul. If they really believe that the soul can and does exist elsewhere when not having an earthly experience, and if they believe that it exists in a blissful, serene, ecstatic, perfect heaven, why do they have such a terrible fear of death? And why do they allow this fear to motivate them to scream so loudly, as if the biophysical aspects of life were the only aspects? Why do they go so far as immorally to deprive people of the quality of life in order to meet technical criteria that life's bioprocesses continue? Of course, biology is sacred, and all bodies are sacred, but only because they are the "temple" of the living Spirit. And a life without consciousness arguably harbors nothing beyond mere physical energy.

Selective treatment is now norm for babies with terrible disorders and deformities, whose quality of life would be seriously compromised and undermined by their physical conditions. In 1983, in a Gallup poll, forty-three percent of Americans said that if their babies were severely defective, they would not wan to keep it alive; they would be doing it no favor in doing so. In one survey, ninety percent of obstetricians and eighty percent of pediatricians had directed that less-than-maximum support be given to seriously defective infants. This occurred, in every case, after a conference with parents, who concurred.

In another survey, ninety-eight percent of physicians rejected the view that everything should be done to save life, unqualifiedly, under all conditions. While physicians support this as "normal medical practice," the courts have also upheld it. In a general survey, only seven percent thought that the doctor should be held guilty in this kind of case. And, in one case, a "right to life" group was even condemned for its interference. This was appropriate, since strangers should have minimum input in a case as personal as infant-survival.

Sometimes, chlorohydrate was used with these infants, and they were told to be fed only when demanding food. This is a sedative, and those who received it made little or no demand for food; and so they were allowed to die peacefully. At any rate, to force any being to live an unwelcome life of degradation, intractable pain, and humiliation is simply an absence of empathy and compassion.

Doctor-assisted suicide falls roughly under the same medical ethical guidelines, even though it concerns adults rather than infants. In cases of horror, where life has become unbearable in many ways, adults with lucid minds , or their relatives, should have the right to demand the end of a futile and unproductive life, especially since a fairly large percent of the life-span has already usually been lived. People should have every right to die while their minds are still clear, to die with dignity and peace, not strapped to a bed being filled and emptied by tubes. This is why, at one point, Michigan's law against assisted suicide was declared unconstitutional. Does the government or the church really have the right to force a person to live, when he or she really, truly wants to die? Can this kind of rigid intrusion be validated?

It is not as if the choice is between dying and living a full, joyful, interactive, productive , satisfying life. Instead, the choice is between a serene death and a life filled with ghastly agonies, horrible humiliations, radical pain, grotesque inconvenience, and endless nightmares of helplessness and hopelessness. Also, when the hellish condition called "life" threatens to continue for years, or decades, should not every free person have a full right to opt for a serene, tranquil drift into the sweet peace of death?

It is due to this consideration that grand juries have refused to indict doctors involved in assisted suicide. Every hospital needs to follow the example of the Netherlands, and establish a "terminal care team," to make the transition into death as pleasant and painless as possible. In fact, we need to establish special thanatoriums, perhaps on hospital grounds, wherein people can die in pleasant environments, that include flowers, waterfalls, music, and beautiful scenes from nature.

This, at any rate, is the wave of the future, as even now, everywhere, the ethics of life-maintenance at all costs are gradually replaced by an ethics of the quality of life, to the relief and joy of good people everywhere, as our planet continues to evolve towards universal love.

*******

Home · Products · Affiliates · Search · Checkout · Contact · Links