Culture of Death: Who Should Decide When to “Pull the Plug”? Families

“People don’t die by the numbers,” writes Wesley J. Smith in National Review. “Some patients prove unexpectedly resilient. Sometimes true miracles occur, or at least there are no scientific explanations for the disappearance of diseases or recovery from ‘non-survivable’ injuries that occasionally take place.”

Smith, a bioethicist, has written Forced Exit: Assisted Suicide and the Duty to Die among other books. In Why Families Should Decide When to ‘Pull Plugs’, he tells the story of a woman who recovered from an injury her doctors insisted she would never recover from. Some states allow doctors to refuse what they consider “futile care” and let the patient die, even over the family’s objections. What’s called “futile” or “inappropriate care,” he explains, is different from “medically ineffective” care. The latter just doesn’t work, like giving the patient antibiotics for a viral infection.

The problem with futile care, he explains, is that it does work and sometimes doctors may think it shouldn’t. “Futile care situations involve value judgments — that continuing to live is too burdensome on the patient or not worth the cost of care,” he writes. “Hence, futile care policies allow doctors and/or hospital bioethics committees to force patients off life-sustaining treatment based on their determination of ultimate non-survivability, permanent disability, ‘quality of life,’ or resource management. And it generally is aimed at removing treatment because it is working — e.g., maintaining the patient’s life — based on subjective belief that the patient is better off dead.”

Futile Care Arrogance

In an article from 2016 titled Futile Care Arrogance, Smith attacked  advance directive laws that let doctors and hospital ethics committees “to veto wanted life-sustaining treatment if they believe the suffering thereby caused is unwarranted — with the cost of care always in the unspoken background. It is a form of ad hoc health care rationing — death panels, if you will — that place the moral values and opinions of strangers over those of the patient and family.” Those committees can be “made up of colleagues who reflect corporate or institutional values, meeting in secret with no real transparency or accountability.”

Defenders of such laws offer a number of reasons to over-ride the patient’s wishes or the wishes of his caregivers. “I have heard such excuses and rationalizations in futile care controversies again and again: The patient doesn’t really know what is best; the family is acting on guilt; misplaced religious belief is forcing a wrong choice; they should leave such decisions to the ‘experts.’ Bah!” He argued that if doctors believe that maintaining a patient’s life is “inhumane, the controversy belongs in open court, with cross examination, an official record, and a right to appeal.”

On Hour of Our Death

“It would seem a cruelty not to grant the last wish of the dying to die. Help them, quickly and quietly, because death is no longer an enemy,” writes Russell Saltzman in Death is Not Your Friend. People now tell us to treat death as a friend. He calls that attitude “a new variety of ‘the denial of death.’” But making a death a friend reduces the value of our lives and those of the loved ones we lose. “Why grieve if death is as natural as a sunset?” he asks.

And then asks: “what does death mean? There is a Christian answer. Death means that God brings us a step nearer to Him. We do not believe we die into nothing. We believe we die into God. If that is in any way true, human life has value beyond measuring. Death is God’s enemy, and ours. And for us through Christ He has promised to destroy it.”

Elizabeth Scalia remembers the end of his brother’s life, when he had lived past the point some would suggest helping him die. “Near the end, our brother went quiet,” she writes in Too Stark For Pastels, But Beautiful, Nevertheless. “Many would contend that what life our brother had left was only pathetic, a life of suffering and sorrow, that counted for nothing. Many would say it. What I say in response is this: My brother’s life at that point was exactly like his life ten years before. It was huge, it was love-filled, and it was fraught with humanity.”

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