Reflection after Eluana’s death
Murder or deliverance?
Kazimierz Szalata
For the last weeks the discussion on the very important moral problems concerning human life has been revived. On the one hand, we have the debate on the moral evaluation of in vitro fertilisation and on the other hand, it was proposed to introduce ‘the last will concerning life support’, which would help to decide about the therapy to be used at the end of human life. Both issues concern the most essential moral questions concerning human life in its most sensitive moments, i.e. its beginning and end. Each debate, regardless of its final result, brings something important into our awareness. Whether we wish that or not it forces us to ask important questions that we usually avoid. However, we should pay attention to the arguments of both parties in order not to get lost in the thick of opinions and stands.
The death of Eluana Englaro
The special occasion to discuss these questions anew was the dramatic events in Italy that brought about the disconnection of the feeding tubes of Eluana Englaro, which led to her quick death. Special meaning was attached to the fact that this case of euthanasia was the wish of the father of the sick woman. Eluana’s death revealed to an even more distinct extent two different visions of human life, which are present in our culture. On the one hand, it is a vision of gift and mystery, which we should guard as the greatest value, and on the other hand, it is a vision of life, which is to be submitted to our evaluations and decisions. It is true that there is something in our nature that does not allow us to submit to the stroke of fate; something that orders us to submit everything that happens around us to our evaluations and decisions. This something is called pride, which is a simple lack of humility. In spite of common opinions humility is not an act of self-resignation but a wise acceptance of the truth about the world and my place in it. The wise ancient Stoics said that much depended on us and we could take many wise and responsible decisions, and actually we must take such decisions every day. But a wise man knows that there is a certain limit to everything. Since some things are not dependent on me and I cannot freely decide about all things. That especially concerns the gift of life which we should treat with due respect. Watching the dramatic reports about the struggle for Eluana’s life we could have the impression that the world was divided between the advocates of the emotional decision of the father who could not agree to keep on her comatose daughter’s life support and those who knew well that life was the most precious gift and we could not destroy it by any decision of ours. Was the disconnection of the feeding tubes through which Eluana was fed such a destruction of life or only deliverance from suffering, which served nothing and after all aimed at unnecessary delayed death? After all the dramatic argument, which lasted only several days, concerned the question about the boundary of human life as well as the difference between stopping life sustaining therapy and euthanasia. For some people Eluana’s death was a murder and for others it was deliverance. Hence some called the decision of the court and the doctors’ treatment ‘a crime’ and others called it ‘an act of mercy.’ It is worth reflecting on the difficult question of ‘life support’, which should not be continued at all costs in the name of the right to a death worthy of a human being, allowing the patient to die peacefully. How can we differentiate between ‘therapy’ and ‘life support’?
‘Therapy’ is an action or a set of actions aiming at improving the insufficient functioning of man’s life processes. All other actions the aims of which are not the patient’s good, regardless of the noble intentions of those that undertake them, are simply manipulations. Therapy becomes life support when it does not serve the patient’s good, which happens when the patient’s condition makes undertaking extraordinary activities irrational and additionally, these activities might cause unnecessary suffering. In case of ‘life support’ we speak about the necessity to withhold the extraordinary means when we know that they cannot bring about expected positive effects, when man is in the phase of irreversible process of agony, inevitably aiming at death. However, the difficulty is not in the theoretical differentiation between therapeutic actions, resuscitation and life support but in their practical implementation. When do we have the right, and even the obligation to stop medical intervention in the organism of a dying person? When is such withholding an act of active or passive euthanasia, even when the patient asked us not to keep on life support? Biological sciences show us death as a certain lasting process. It is not easy at all to find such a moment in which this process is irreversible and inevitably leads to immediate death. (Actually, every human life inevitably aims at death.) When I talk to experienced doctors I often hear that their whole professional experiences related to their medical practices have led them to discover one truth – in spite of the huge progress in medical sciences life is still a mystery and an honest medical practice is a school of humility. Perhaps the difficult issue of the relevant differentiation between suitable therapy of a patient and life support that contradicts the patient’s good reveals to us that besides knowledge medical activities require ordinary wisdom. I think that we forget about that, seeking answers to the existential, in fact philosophical, question about the limits of life among the empirical data of the highly advanced measuring apparatuses alone. Furthermore, we have an increasing problem with accepting suffering as a simple fact resulting from the human psychophysical condition. Yes, suffering is inscribed in man’s life despite the fact that it causes fear, sometimes horror, provoking us to escape into delusion that we can avoid suffering, sometimes even at the cost of life.
Stop blurring the line between the truth and emotions
When asked about the evaluation of ‘the final solution’ of the problem of comatose Eluana I had no doubts that it was a case of euthanasia, or as some say ‘a wish to die’, in this case the father’s wish. But at the same time I would not dare to evaluate the desperate request of the father not to keep on life support of a loved one that had no contacts with the surrounding for years. He had the right to react emotionally, from the fatherly perspective towards his child. However, as we know very well, it was the court consisting of people appointed to take rational (and not emotional, sentimental or opportunistic) decisions that decided to disconnect Eluana from feeding tubes (death by starvation!). The same refers to the doctors who executed the father’s will, confirmed by the dignity of the court. This is the perversion of the euthanasia logic that shows a doctor as a deliverer through changing his century clearly-depicted tradition of the Hippocratic role of patron and guardian of health and life into a gloomy role of the angel of death. Why was Eluana’s death a case of euthanasia and not stopping life support? The fundamental argument that allows us to clearly evaluate of what happened in ‘the house of help’ in Udine, Italy, is the fact that the comatose woman did not receive any extraordinary means that characterise life support. She could breathe without a respirator. That ‘extraordinary therapy’ that was withheld was feeding tubes. Can feeding be called an extraordinary activity? After all every healthy human being can die by starvation without having access to food. That was Eulana’s death. And this tragic fact cannot be concealed by any kind, moving, allegedly humanitarian speculation.
‘Last will concerning life support’
One of the dramatic attempts to block the court decision allowing Eluana’s death by starvation, undertaken by the Italian government was to introduce ‘last will concerning life support’ by which everyone could express his/her will to keep on or stop life support. Naturally, if such a document had been introduced in Italy Eluana, who had never signed any declaration of this kind, could have been saved. But that could have happened thanks to some legal manoeuvre that might have been used to stop this particular case of euthanasia. But we know that Eluana died before anything could have been done. However, we should not have the deceptive impression that the introduction of such a declaration in the form of ‘last will’ will be sufficient in any other similar case. Frankly speaking, for some time I have listened carefully to the arguments repeated in the discussion on this ‘last will’ in Poland and I have more and more doubts concerning the usefulness of such a document. Since if every medical doctor is obliged to save human life by using available resuscitative and therapeutic means, and when these extraordinary means lose their rational grounds, becoming only life support, with no expected positive effects, which would stop the process of inevitable death, he is obliged to withhold them, one can ask a fundamental question: who exactly needs such a last will? It is supposed to be a document expressing my desire concerning keeping on or stopping life support when I face an inevitable death. Every medical doctor knows well what life support, without any promising positive effects, is. Let us repeat the definition: it is as if unnecessary prolongation of agony and as such is recognised as contrary to the dignity of human person and his/her right to die a worthy death. The principle is simple. Of course, its implementation is difficult and even very difficult. Using their professional knowledge and personal wisdom doctors must define when to withhold medical activities and let their patients die. How could the last will help them in that? Even if someone wrote that the resuscitation must be stopped when he/she could not breathe and the doctor fulfilled the last will despite the fact that the patient’s processes could be restored, he would do passive euthanasia. And this is a crime. Similarly, if someone wrote that despite no chances to stop the inevitable process of dying the resuscitation activities must be continued for some time a doctor cannot fulfil such a command. Therefore, how can a doctor treat ‘last will’? It is said that because of this declaration the patient will have the possibility to decide about his/her future fate. But can I foresee the situation at the end of my life? Can I evaluate my condition better than the doctor that knows the recent research results and his knowledge is based on medical sciences?
Miracle of life
The temptation to commit suicide occurs in specific emotional conditions and it is one of the stages of despair. It is never rational since there are no grounds for self-destruction. Whereas there are psychological conditions that can suggest such a self-destruction as escape from what overwhelms us. An attempt on life, giving up the fundamental value, that extraordinary gift thanks to which we are present in the world is never based on free, rational decision. That’s why we cannot evaluate suicidal acts. Naturally, suicide, self-mutilation, is always wrong but can result from the devastation of our rational personal life. However, in case of euthanasia, which we can actually understand as the fulfilment of the patient’s wish, it is the doctor (someone who should act rationally) that executes the dramatic will to end one’s own life. We can say even more. We speak about the necessity of the support of a committee embracing ‘specialists in good death.’ But besides despair, fear and the temptation to run away to which a suffering man has the right, no rational thinking has reasons for killing, even if someone asks us to do so. Even if the request was written in the document called ‘life will’. Human life is a real miracle, is a mystery that allows us to participate in family, professional and social life. It is a gift that we should accept with love and care even if it would mean great cost for us. You cannot escape the truth that the risk to confront suffering is inscribed in life. It depends on our maturity whether we can accept it or panic-struck fall into the abyss of death that annihilates us.
"Niedziela" 10/2009