At the End of Life, the Beginning of a Debate
Published: Friday, January 31, 2014
Updated: Friday, January 31, 2014 01:01
Right-to-life debates frequently call on the general public to consider the point at which a meaningful life begins. However, we are seldom asked to consider the point at which a meaningful life has ended. This is the central question that stands at the core of two recent medical disputes, both involving the decision to remove a patient from life support.
In the first case, 13-year-old Jahi McMath suffered severe complications following an operation to remove her tonsils, adenoids and extra sinus tissue. She was declared brain dead Dec. 12, three days after the operation, but her family, hoping for a miraculous recovery, has since insisted that she remain on life support.
In the second case, 33-year-old Marlise Muñoz was found unresponsive on the kitchen floor by her husband Nov. 26. Because she was 14 weeks pregnant, the hospital refused to remove her ventilator despite her end-of-life wishes, instead stating that the unborn child should be protected under state law. The ventilator was finally removed Sunday after a judge declared that the law did not apply to those who had already died.
Each case has raised unique ethical questions: How should the religious convictions of patients be respected? How should the conflicting medical interests of mothers and their unborn children be addressed? But common to both cases is the fact that the patients in question were declared brain dead, calling into discussion the ethics of maintaining the heartbeat and breathing of patients who have no realistic chance of recovery.
While both cases bring to mind Terri Schiavo, who was at the center of a seven-year battle beginning in 1990 over the continuation of her life support, these cases unfortunately differ in a significant way. Unlike Schiavo, who was in a persistent vegetative state — also known as a coma — neither McMath nor Muñoz maintain any brain function. A patient in a coma may, depending on the circumstances, be able to live a meaningful life in the future. Sadly, brain-dead patients like McMath and Munoz have no chance of ever recovering.
This raises the issue of what makes a life meaningful and worth protecting. According to Princeton ethicist Peter Singer, “If you think that somehow what is precious, or what has a right to life, is simply an organism, then I suppose you might say, ‘Well, this is not dead. This organism is still able to function. It needs medical support, but of course there’s a lot of people who need medical support.’”
However, brain-dead individuals are not able to, and will not ever again be able to, think, feel emotion or even sustain basic life functions such as breathing. For this reason, most hospitals accept the absence of brain functioning as the point at which an individual may be officially declared dead.
While Muñoz has been removed from her ventilator and her body released to her family, fundamental misunderstandings about the meaning of brain death have been influential in the decision to keep McMath on ventilators.
McMath’s mother, Nailah Winkfield, has stated that only her daughter’s heart stopping would be cause for her to give up hope that her daughter may recover, telling reporters, “I can’t play God. She’s going to get better or she’s not, but I see her getting better.”
Those who work to reinforce this false hope have only made the matter worse. The Terri Schiavo Life & Hope Network, which has been working behind the scenes to help the family keep McMath attached to life support, is one such organization. According to a statement released by the organization, “Jahi McMath has been labeled a ‘deceased’ person. Yet she retains all the functional attributes of a living person, despite her brain injury.”
Statements such as this one are false and unethical. While machines may be able to keep this young girl breathing and her heart pumping blood, it would take a true miracle for this girl to come back to a life that is arguably worth living. One cannot blame the girl’s family for holding onto all hope that she may recover. After all, the loss of a child is devastating. But false information about the severity of McMath’s condition only postpones the inevitable grieving process that this family faces.
Statements that reaffirm the family’s misconceptions are additionally unethical from a societal-welfare perspective. The resources required to keep a deceased person artificially breathing are also resources that could be better utilized to care for those still alive, and some philosophers, including Singer, have even argued that the organs of brain-dead individuals could and should be used to save the lives of others.
The experiences of the families of both McMath and Muñoz can be described as nothing short of tragic. But denying the inevitable only serves to harm all those involved.
CORRINE SCHMIDT is a senior in the School of Foreign Service. She is captain of the Bioethics Debate Team.