Monday, March 21, 2005

When does death take place?

I recently realized that the book I am working on, "What does it mean to be human?" was not going to be much if I did not work with someone who is medically trained and a bioethicist. That was when I met Dr. Joy Riley, the area director of the Center for Bioethics and the Culture, a Christian network that is concerned for the human future.

While we were doing some planning of the book a few weeks ago Joy raised the thorny question that is before Christians and the whole culture today of when death occurs. I sat and listened, fascinated, for ten or fifteen minutes as she outlined all the complexities that have now crept in as a result of medical advance, new techniques for recovering individuals from what were once terminal conditions, and so forth.

Before she had talked to me I had known enough about this topic to speak sweepingly and get into real trouble. Now I realize just how little I do know, how complex this issue is, and how careful we need to be when assessing death-related issues. This concern has now been highlighted by the Terri Schiavo case from Florida, which in the last few days has become a political football in the "life" debate, with everyone including the Congress weighing in.

Yesterday evening, with the help of the press, the internet, various cable channels, and watching Congress on C-SPAN, I tried to get a handle on what this is all about because I could not (and still cannot) work out how much is concern for the good of the patient, and how much is the snowballing of a family feud over the treatment of a woman who is tragically caught in a limbo somewhere between living and dying.

As I watched the congressional debate I guessed it was a microcosm of the wider debate that is taking place, with moments of lucidity and powerful insight being punctuated by partially informed passion, playing to the political gallery back home, and oceans of rhetoric. This actually was not a debate, but it was two sides lobbing verbal grenades, of which little notice was being taken. It was fascinating to hear an MD who is also a congressman speaking about the care he needed to take as a medical professional who had not examined the patient, and then to listen to the rant that came from the speaker immediately after him, and which totally ignored the doctor's caution.

The issue at stake here is one that is going to dog us increasingly in the years ahead. It seems that Mrs. Schiavo has been for so long in a persistent vegitative state that the likelihood of any recovery is minimal, and circumstances like this will grow more common. Her condition probably means that here higher brain is no longer functioning, and all that is alive is the lower functions that control existence. The question is whether she is dead or whether she is alive ro whether she is somewhere between the two -- and what that place is.

The woman's parents and siblings are convinced that she is responsive to their presence, while the majority of the physicians who have examined her have suggested that the only responses she makes are reflexive actions. In this instance a place seems to have been reached where family love and sentiment are playing as significant a role as medical insight and analysis. I am convinced that ever side, including the much maligned husband, wants wants is best for this poor lady, but "soft" evidence and "hard" evidence have come crashing up against one another. Maybe this is a peculariarly postmodern dilemma because "soft" data is considered as valid as "hard" evidence.

Joy Riley is helping me see that whatever your religious affiliation or faith commitment, Christian or ortherwise, there are seldom simple solutions in cases like this. What this does is raise again the issues that our culture is avoiding about what it means to be human, when does human life begin, and when does it end. We are addressing the symptoms and not the underlying causes of our travail.

The question I was not hearing addressed in Congress last night was whether this woman is alive or not. Is a persistent vegetative state human life or is it something else? When the higher activities of the brain give out, what does that do to our humanity? Is Mrs. Schiavo living or is she existing? The questions are endless, but we who are serious about life need to be addressing them with informed reason and in light of biblical principles, remembering that there probably are no easy rule of thumb answers to such far-reaching questions.

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