Dead or Alive?
By JIM NICHOLS
As we have seen in the Roe versus Wade arguments, sometimes personal and moral decisions wander into legal areas and the water becomes muddy quickly. Precedents are set and then arguments begin concerning whether precedents are binding or not. The making or rejection of laws, to simplify matters, seems to add complications rather than clarifications. A recent newspaper note identified another such issue.
The local paper has a column headed “Today in History.” There one can find sentence-long identifications of noteworthy or interesting news items from the past. Some are from centuries ago and some are from last year. Some are related to sports, some to wars, some to notable births or deaths.
Recently the note appeared that on that date in 1985 “Karen Ann Quinlan died at 31 years old.” Since her saga, there have been other equally gut-wrenching circumstances, but hers was one of the earliest. It opened to many the questions of life and death and blended medical and legal issues into sociology and theology.
Adopted at four-weeks old from a home for un-wed mothers, she was reared in New Jersey in a conservative Catholic home with parents and two siblings. Ten years before she died of pneumonia, she weighed 115 pounds and was 21 years old; when she expired, she weighed 65 pounds. She slipped into a coma following the consumption of alcohol and tranquilizers. She never regained consciousness.
Over the next few months her weight decreased markedly. All examining physicians noted that, preceding the coma, she had been without oxygen for multiple minutes. They agreed that she had suffered irreversible brain damage. Her electroencephalogram wave was not totally flat, but she had no cognitive or cerebral functioning. She had no prospect of recovery and was in a “persistent vegetative state.” However, was she dead?
This was all occurring in the mid-1970s and was one of the early illustrations of the results of medical advances. Until the 1950s everyone had a quite clear and definite understanding of when someone died; when the person stopped breathing and the heart stopped, that person was no longer alive. The development of positive pressure machines that kept ventilation (breathing) continuing changed the landscape. Various committees and organizations began proposing “definitions” of when death did or did not occur.
The discussions focused mainly on two alternatives. Roughly explained, brain function can be localized into two regions. (1) Awareness and consciousness seem to reside in what might be called the “higher” brain. (2) At the base of the brain (brain stem, more like the top of the spinal cord) are situated many automatic activities including ventilation regulation and accompanying heart rate regulations. Thus, it was understood that a person could lose awareness and consciousness but continue all the automatic normal rhythms such as breathing. Or one could lose both sets of capabilities.
Because Karen Quinlan had been put on a ventilator immediately after her crisis, her situation was unclear.
As the summer of l975 continued, her parents kept vigil but eventually accepted that she would never regain consciousness. In a series of discussions, they believed that they had convinced her medical team to discontinue the respirator. Concerned about medical and legal precedents, the team changed its mind. The Quinlans then filed a lawsuit asking that the respirator be discontinued and that their daughter be allowed to die. In March of the following year, the New Jersey Supreme Court ruled in favor of the parents. Within weeks, the respirator was removed.
Interestingly enough, the parents did not request removal of the naso-gastric tube supplying hydration and nutrition. Removing that opens another whole set of medical, moral, and theological questions that remain problematic.
Karen Quinlan lived from 1976 to 1985 breathing on her own.
There is, of course, a high probability that neither you nor I will face a similar dramatic situation. As we move through life, however, it is important that we occasionally consider the complications of life and death. Few of us alive today will be so 100 years from now. 75 years from now? 50? 25?
Have you assigned a person (“medical power of attorney”) to make medical decisions for you if you are incapable? Does that person understand your wishes?
How does what we conclude about the end of life help us think about the beginning of a life? Or does it? How consistent are our values?
Shallow thinking on some topics does not work.
Jim Nichols is a retired Abilene Christian University biology professor and current hospice chaplain