Some Background for End of Life Discussions

In theological discussions death is described as the time when body and soul separate.  But when this occurs cannot be determined exactly.  For medical and legal purposes, brain death is described as the time when the whole brain ceases to function.  This judgment is usually based on professional observations that breathing has stopped, the heart is no longer beating, and corneal eye reflexes are no longer present, this state of affairs having existed for at least four minutes (and much longer in cases of electrocution, cold water drowning, or drug overdose.  This is a more pragmatic and much more common approach than examining an electroencephalogram (EEG) and finding no signs of brain activity.

Death is inevitable and most of us are content to set our own standards of risk, living and dying by our choices of food and drink, exercise, employment, driving speed and attention, flying, etc.  Of course, heredity is the first card dealt in this game of life.  The first time many people seriously consider the end of their life is after being diagnosed with some disease and then asking themselves and their doctor “How long do I have?”

However, in modern times, the media cause many to speculate about end of life decisions by bringing to our attention the plight of individuals and their families faced with not- so- unusual circumstances that have arisen in part due to advances in medical technology and its ability to maintain critical physiological functions.  In many cases, if the machines/devices, the “life support systems” that may have been used are removed, the patient will die soon thereafter.  The families and health care workers are burdened with the responsibility of making an ethical/moral decision, and they need all the objective information they can garner.  Subjective considerations also must be taken into account.  Is the technology simply delaying the inevitable, unnecessarily prolonging the normal process of dying?  What type of life is possible if the treatments are successful?  Are the treatments painful?  Are they merely palliative or are they curative?  And importantly under the legal and moral right of self-determination, the expressed or even carefully surmised desire of the patient must weigh heavily with the decision-makers.  Where the drama unfortunately plays out in public, the media and the public should not rush to conclusions without having all the facts and considering the advice of those experienced in such matters.

In future columns we will consider the definition of terms pertinent to end of life issues such as unconsciousness, stupor, coma, persistent vs permanent vegetative state, food and nutrition, ordinary vs extraordinary means of life support, the medical concept of “futility”, quality of life, palliative sedation, euthanasia, assisted suicide, etc. What is a living will? What does it contain? Should you have one? What is a Health Care Power of Attorney?   More to come.

Peter Moore, PhD    George A. Sprecace, M.D., J.D.