Thursday, April 06, 2006

Quality or Quantity?

I've had occasion to consider this with one of my patients. She is only a few months old, but she suffered some considerable complications during or before her birth, it isn't clear which. She will likely never progress from her current state, which is that she can swallow, weakly and only occasionally, she cannot protect her airway, so she aspirates food into her lungs, and she suffers recurrent seizures. She has an EEG displaying burst supression, which is just one step removed from brain dead. In a particularly difficult patient encounter, our pediatric neurologist told the father that, though pediatric brain injury prognosis is difficult to predict, his daughter would likely never feed herself, walk, comunicate, see, hear, or even have a thought. The father's response was "why didn't you kill her along time ago then?"

Though of course actively euthanizing patients in prima facie wrong, I don't know that answer is a good one. Should patients with no hope of recovery be kept alive like this? It's not like that media circus Terri Schiavo case, here the patient has never interacted with anyone. She was born unresponsive and displays nothing but the most primitive of reflexes now. She is only alive because of medical miracles and heroic support measures undertaken at birth, but right now, she doesn't need anything but a tube feed. The argument against letting Mrs. Schiavo die was that a tube feed is not a heroic measure. But I think that's a poor one in this situation.

True, it isn't heroic, but what is heroism but defense of a worthy cause? I'm no longer able to say I believe life is, in the abstract, a worthy cause. I don't know what is. What is it that makes a life worth defending? How do we define "humanness" here? "In the image of God we are made" but how much of that image is interaction, is thought, is contribution, is soul? And how much is the "crude matter" which comprises our physical form?


Thainamu said...

Sigh. Our technology has advanced much quicker than our ability to deal with its results.

S. Lee said...

The Kurzweilian (or rather, the Simpsons-esque) future will show whether or not we try and sustain life beyond the natural organic lifespan to a larger degree than is already occurring. The questions are not unrelated, however. Yes, the question should be, "How does God define/determine human life?" Is service to this unconscious child glorifying God?

Ibid said...

Not an easy question, and I fear I would do an answer injustice, since I have never had to actually deal with this. I would suggest you check out my dad's blog, as he, a doctor, just recently posted on the subject.

MrStandfast said...

God isn't a biped. Or maybe he is. But that's not that relevent. I don't think bilateral symmetry has anything to do with his image. I've heard it postulated that as we know God only by his revealed word, then it is our wordness, our creative self that is the image of God. I like this observation because it does not overblow, as Yoda once said "this crude matter." Unlike Yoda though, we as Christians believe there to be something particular and special about that crude matter, and acknowledge that we're not just "luminous beings". enough return of the Jedi.

The crossroads you're at in thinking about it is no simple puzzle though. I'm not too blind to see that. Let me say this though. Life is absolutely, in abstract, in concrete a worthy cause. That said, for the Christian there are worse fates than death. God made us masters of the created order, responsible for it, but also over it. This is where science comes in. These means are perfectly within our grasp as little creators, created in the image of the The Creator. So we're left with the connundrum of what is life?

The girl, that's a heartbreaking situation, it doesn't matter which way you slice it. It is hard and painful and immediately counterintuitive that something could be happening to an apparent innocent. The Christians answer is of course not easy either. This child is not guiltless, nor is she by necessity being punished. But where does that leave us? I'm told the U.S has the earliest viabilty in the world for infants. I think that this story is sad. I can't say just how sad it seems to me now, and how hard it is to deal with. I don't think I could be the one to keep her alive. I just don't.

Nathan said...

thainamu - exactly.

s. lee - I like the way you've rephrased the question, especially the second one. For that, truly, should be the first consideration when examining our lives. What a staggering thought.

ibid - Thanks for visiting, and thanks for the link. Your dad seems like a thoughtful, cool guy, just the sort of doctor I hope to be someday.

mrstandfast - You've hit exactly on my thoughts here. It's a sad situation, and there are no easy answers, but I don't want to be the one making the decision to keep her alive. If it were up to me, I'd probably be advising the parents against further intervention. But it's not, and I didn't