by David Anderson
Death is an undeniable aspect of life. It is certain, final, and inevitable. We know it when we see it. Or do we? Death is changing. The way we define it, experience it, and make choices about it are much different than the generation before. The moment of death is still instantaneous, but the process has elongated — creating a myriad of ethical dilemmas. For most Americans, death will be a managed experience endured in a long-term medical facility with a possible move to a hospice in the final weeks.
To effectively comfort a dying believer and his/her family, we must have a working knowledge of Biblical principles and the terminology, technology, and ramifications of advances of medical science. Many of these advances produce disturbing and unavoidable questions with moral repercussions, such as; When is it acceptable to remove or withhold life support? Is it right to administer morphine if doing so diminishes pain but accelerates death? Is CPR always appropriate? Does requesting a Do Not Resuscitate order (DNR) or Allow Natural Death order (AND) violate the sanctity of life? What is the difference between coma, persistent vegetative state, and brain death?
In healthcare, a bioethical dilemma develops when complex and conflicting factors converge to create a problem that appears to have one or more feasible solutions, each with equally plausible merit. Assessing the ethics and/or morality of the options can be extremely difficult. For example, in August of 1997, a woman from Brockport, NY, suffered a massive cerebral hemorrhage and was placed on life support. Soon after, she was declared brain dead by the attending physicians. According to New York State Law, once whole-brain death occurs, the patient is to be immediately removed from mechanical life support. The physicians chose instead to keep her body functioning with artificial assistance. Was this ethical? Was it moral? Since this woman was dead, what circumstance could possibly justify keeping her on life support?
If your initial reaction to this story is that the physicians were wrong for keeping her on life support, would any of the following scenarios cause you to re-evaluate your assessment? 1) Her organs were healthy and perfect for transplantation if her body was kept functioning until the organs were needed. 2) Her hemorrhage was due to a rare disease that doctors could study more thoroughly and effectively if they kept her on life support. 3) Her loving family had requested the life support for just a couple of extra days so they could have time to gather for their last goodbyes. 4) After the declaration of brain death, her limbs moved and her eyes tracked people across the room. 5) Her Living Will clearly stated that as long as her body could function, even if her brain ceased functioning, she was to be kept on life support.
In this case, none of these applied. There was another reason for not removing the mechanical life support. She was pregnant. The physicians believed they could keep her body “alive” for three months and deliver the baby by Cesarean section. They did so, and on November 14, 1997, a 15-inch baby girl was born just 31 weeks after her conception. Almost immediately after delivery, the mother was removed from life support and expired. At the time, this was one of the only cases of such an occurrence, but since 1997 it has happened numerous times.
Did the fact that she was pregnant change your opinion? Did the outcome of a healthy baby persuade you that the doctors made the right decision? For most of us, the pregnancy and baby delivery resolve the issue, but there are other questions. If the woman was dead, who had authority over her body? Can only doctors violate state law regarding health care? How long can physicians keep someone “alive?” What were the wishes of the father of the baby, the parents of the mother, or the mother herself?
A newspaper account of this event revealed that the father of the baby opposed life support and refused to participate. The woman’s parents petitioned the court to remove all life support. Neither agreed with the physicians’ decision, and neither made any commitments to take care of the baby should it survive delivery. This decision, whether it was right or wrong, was based upon the physicians’ value system, rather than that of the family. Is that ethically, morally, and spiritually acceptable? Who do you want making medical decisions for your family?
Will you trust the physician handling your care, or what the Affordable Healthcare Act mandates, or what a lawyer, court, or judge determines is acceptable?
Every week, end-of-life scenarios, transplantation protocols, blood transfusion rules, futile care parameters, stem cell and genetic therapies, feeding tubes, ventilators, rationing, emergency guidelines, immunization, physician-assisted suicide, abortion, and reproductive procedures are being discussed in hospital bioethics committees, medical schools, state legislatures, philosophy departments, law schools, and courtrooms — everywhere, but the church.
As my first pastor, Charlie Yates, use to say, “Brethren, these things ought not so to be.” We need to get involved in the debates and shine Biblical light on the rapidly growing catalogue of bioethical dilemmas. If we don’t, we have no one to blame but ourselves for the darkness that will ensue.
David Anderson (pastordave@fbcsarasota.com) is pastor of Faith Baptist Church, Sarasota, FL. He is a board member of the Florida Bioethics Network and a member of the Sarasota Memorial Hospital Bioethics Committee.