Death and Dying

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Death and Dying | Introduction

A February 1997 Los Angeles Times article tells the story of a ten-yearold girl whose death from a malignant brain tumor became the center of a bioethical controversy over how to define death and when to end life-prolonging medical treatment. The doctors who first diagnosed the tumor immediately concluded that it was terminal. They decided that it was futile to operate on the girl since the cancer would inevitably grow and spread, and they advised the girl’s family that the only useful medical treatment would be painkillers to keep her as comfortable as possible while she died. But the girl’s parents, who believed that it was not their daughter’s time to die, wished to pursue every measure to try to keep her alive. They sought out doctors at another hospital who were willing to perform the operation to remove the tumor.

When brain surgery failed to cure the spreading cancer, however, the young girl’s condition rapidly deteriorated. She soon fell into a coma and was placed on life support to provide her nutrition and hydration. As the girl’s brain tumor grew, the doctors became convinced that her coma was irreversible. A few of the doctors involved in the case felt that since she was in a permanent vegetative state, they would be justified in stopping the nutrition and hydration that kept her alive. They tried to persuade the parents to discontinue life-support measures and allow the girl to die. But the family adamantly resisted this suggestion, arguing that it would amount to killing the young girl. The parents strongly felt that removing their daughter’s feeding tubes would cause her to experience a painful and undignified death. They opted to continue medical treatment to prolong her life.

When the tumor finally metastasized throughout the girl’s brain, all brain activity seemed to cease. Finding no blood flow to the brain, doctors declared the young girl brain-dead. Since her heart and lungs could no longer function independently, she met all the medical and legal criteria for the diagnosis. But the parents rejected the idea of brain death. They pointed out that her body was still warm and she was still assimilating food and water.With the aid of respiratory machines, they believed, she could maintain these minimal life signs and organ functions in- definitely. The family insisted that life-support systems be used to keep the girl’s heart and lungs working.

For more than a year after doctors had declared her braindead, the girl was kept on these life-support machines, necessitating round-the-clock medical care. On several occasions she required CPR or other medical attention to keep her heart and lungs going, but other organs continued to function as before. All along, doctors argued that the life-support measures should be ended, but the parents steadfastly insisted that their daughter was still alive. It was only when all signs of life finally ceased that the family acknowledged that the little girl was dead.

During the months that the little girl’s status was disputed, her case became a source of controversy among bioethicists. Some asserted that disconnecting the girl’s life-support systems would be unjustifiable since doing so would certainly result in the loss of whatever life she had. But others maintained that it was absurd to keep her already-dead body hooked to these machines. The contentions over this particular case mirror broader debates in the medical community over how and when to limit the use of medical technology in prolonging the life of terminally ill patients.

Some in the field of medical ethics contend that when technological means are used to extend the life of dying patients, particularly when there is no possibility of a cure or recovery, the patients suffer unnatural and horrifying deaths. Among those who hold this view is Daniel Callahan, author of the 1993 book The Troubled Dream of Life: Living with Mortality and former president of the Hastings Center, a leading bioethics research organization. He criticizes the effect that the development of lifeprolonging technology has had on medical ethics, stating that it “has led us to think of death as a curable condition, or at least indefinitely postponable.”

Because twentieth-century medical technology has made dramatic leaps in curing diseases, according to Callahan, many doctors and laypersons have come to mistakenly believe that all deaths could be prevented with new technological developments. This belief, he contends, has led some to wrongly conclude that withholding measures that could extend the life of dying patients is tantamount to killing them. The resulting overuse of life-support machines has caused drawn-out suffering for many terminal patients, Callahan asserts. Above all, he argues, doctors and laypersons should bear in mind that death is the natural end of life. Doctors should be as concerned about preventing technologically horrific deaths as they are about pre- serving life, he concludes.

Other bioethicists, however, maintain that although patients should not be made to suffer by the use of life-support measures that are futile or burdensome to them, medical professionals should always strive to preserve the lives of patients through any means available. Among those who subscribe to this position is Gilbert Meilaender, a medical ethicist who teaches in the Department of Religion at Oberlin College in Ohio. He cautions that when doctors make a decision not to use life-prolonging technology and to allow patients to die, they may be “deliberately letting people die who aren’t really dying—and doing so simply because [they] think their lives aren’t worth preserving.” In Meilaender’s opinion, it is morally unacceptable for doctors or patients to decline medical treatment in order to achieve a hastened death in the hope of avoiding a prolonged or more painful death down the road. It is impossible for doctors to predict whether patients will suffer worse deaths if their lives are prolonged, he contends, and in some cases, such as the permanent vegetative state, it is difficult for doctors to know whether treatment is burdensome to patients. Therefore, he concludes, doctors should always presume that the lives of patients are worth preserving and, unless death is truly imminent, they should employ life-prolonging medical technology.

The dispute over when death occurs and when lifeprolonging treatment becomes unwarranted is just one of many issuessurrounding health care at the end of life that have arisen due to the rapid development of medical technology in the twentieth century. As a way of exploring these issues, Death & Dying: Opposing Viewpoints presents debates on the following questions: At What Point Can Treatment for Terminally Ill Patients Be Stopped? Do Individuals Have a Right to Die? How Can People Cope with Death? Is Death the End of Life? These chapters examine the myriad ways people view death and dying.

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1. Introduction
2. At What Point Can Treatment for Terminally Ill Patients Be Stopped?
   1. Chapter 1 Preface
   2. Treatment Should Be Stopped Once Higher-Brain Death Has Occurred
   3. Higher-Brain Death May Not Justify Stopping Treatment
   4. Nutritional Life Support Can Be Withheld From The Terminally Ill
   5. Nutritional Life Support Should not be Withheld from the Terminally Ill
   6. Periodical Bibliograpy
3. Do Individuals Have a Right to Die?
   1. Chapter 2 Preface
   2. The Constitution Protects The Right to Die
   3. The Constitution Does Not Protect The Right To Die
   4. Physician-Assisted Death Should Be Legalized
   5. Physician-Assisted Death Should Not Be Legalized
   6. Advance Directives Protect The Right To Die
   7. Advance Directives May Not Protect The Right To LIve
   8. Periodical Bibliography
4. How Can People Cope with Death?
   1. Chaper 3 Preface
   2. Grief Should Be Shared Publicly
   3. Grief Need Not Be Shared Publicly
   4. Grief Follows A More Or Less Predictable Pattern
   5. Friends Can Help The Grieving Process
   6. Funerals Should Celebrate The Life Of The Deceased
   7. Funerals Should Help Survivors To Confront Death
   8. Periodical Bibliograhpy
5. Is Death the End of Life?
   1. Chaper 4 Preface
   2. Near-Death Experiences Are Glimpses Of The Afterlife
   3. Near-Death Experiences May Not Be Glimpses Of The Afterlife
   4. Near-Death Experiences Are Not Glimpses Of An Afterlife
   5. Cryonic Suspension Can Extend Life Beyond Death
   6. Cryonic Suspension Cannot Extend Life Beyond Death
   7. Periodical Bibliography
6. For Further Discussion
7. Organizations to Contact
8. Bibliography
9. Copyright

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