Friday, January 4, 2008

What to Do

It is our choice of good or evil that determines our character, not our opinion about good or evil.

—Aristotle, Nicomachean Ethics

A Philadelphian, Terri Schiavo weighed more than 100kgs as she turned eighteen in 1981. Obesity is a calamity for Americans; calamities have become regular recipes for Americans prepared by their President - whether in Iraq or in New Orleans. Schiavo was weighed down as much by her weight as she was by herself that before she married Michael Schiavo, she lost an impressive 45 kgs and gradually lost more to mold herself into a pretty lady. But, in 1984, she had a cardiac arrest leading to brain damage. “The cause was a drastically reduced level of potassium in her bloodstream, a condition frequently associated with bulimia.”

Usually common in young women, Bulimia is a psychological disorder where one eats uncontrollably (bingeing) and then submits herself to feelings of guilt and depression so much that they try to vomit by themselves. It is a typical eating disorder that is extremely disturbing and disorienting to one’s state of mind.

After recovering from coma, Schiavo was to enter into a “persistent vegetative state.”(PVS) PVS is a “condition of patients with severe brain damage in whom coma has progressed to a state of wakefulness without detectable awareness.” Unlike coma, PVS patients often open their eyes. They may experience sleep-wake cycles, or be in a state of chronic wakefulness. They may exhibit some behaviors that can be construed as arising from partial consciousness, such as grinding their teeth, swallowing, smiling, shedding tears, grunting, moaning, or screaming without any apparent external stimulus.

Yet, Schiavo’s functioning brain stem - connecting the spinal cord with the brain responsible for involuntary movements like heartbeat, digestion, respiration and sleep rhythms - was nourished by liquid food fed through an opening made into her abdomen. Her husband waited for her to recover but knew that there was little chance of any progress. Even if Schiavo regained her consciousness from PVS, she could as well experience debilitating disability. But, Schiavo’s parents insisted on her right to live as she was regularly responding to them by smiling sometimes or startling them on other occasions.

All signs of partial consciousness! But the medical motley reached a near agreement that Schiavo’s condition no way seems to be life-like. Neurologists had unanimously agreed that Schiavo’s prolonged stay in PVS can help develop severe disabilities. “At this point,” the Florida Supreme Court opined, “much of her cerebral cortex is simply gone and has been replaced by cerebral spinal fluid. Medicine cannot cure this condition. Unless an act of God, a true miracle, were to recreate her brain, Theresa will always remain in an unconscious, reflexive state.” Another popular patient in PVS is the former prime minister of Israel, Ariel Sharon who has been incapacitated by the stroke he suffered in December last year.

Early 2005, Schiavo’s medical condition turned into a media spectacle when George Bush and Senate Majority Leader Tom DeLay wanted to save Schiavo’s right to live by instructing the judiciary to look into the case before time runs out. The Right sided with Schiavo’s parents and there was an anxious America waiting for the result. Two sittings of the Florida court couldn’t merry the Right and what was left was the removal of the Terri’s feeding tube on March 18, 2005 to let her gradually and peacefully die by the end of March.

The Right argued that no human can grab the life awarded by God and He is the only one to take it back. DeLay went on to predict the judgment to be awarded by the One on the top of us. He gave an earthly verdict to the killers of Schiavo that if not today, there will payback time tomorrow. Writing in the National Review, Ramesh Ponnuru pleased his readers by inventing a “party of death,” which is in large part the Democratic Party with few “outposts” in the Republican Party. For Mr. Ponnuru, pro-lifers like Republicans enliven America even if their sloppy foreign policies snap lives outside America. Life after all is precious; but to live a dead life is no human experience at all.

I don’t know if euthanasia is really a favorable way to relieve patients like Schiavo of their dead life. But, somehow this dilemma ducked away when I watched the 2005 Oscar winner, Million Dollar Baby. In which, the boxing trainer Clint Eastwood trains Hillary Swank to make her into a champ boxer. Swank suffers a brain injury during one of the matches in the boxing ring. In between the rounds, she slips on a stool she is supposed to sit with her neck falling on one of the hinges of stool. She seriously injures her brain stem and is in debilitating despair. Incapable to stand the insurmountable pain, she requests Eastwood to kill him.

On one occasion, she even bloodily bites her lips unable to endure the punishing pain. Eastwood is in a fix: whether to kill her or let her live. As he had trained her to her fatal fall, Eastwood searches for answers to solve his dilemma and visits his Church. The pastor appreciates Eastwood’s regular church-coming for over 28 years, but scolds Eastwood for trying to snatch God-given life. Eastwood is gripped by the guilt that he was solely responsible for the plight of his beloved boxer. Ultimately, the pastor counsels Eastwood to act justly. And asks him to forget God, his Judgment and just listen to the truth inside him. That night, Eastwood lethally injects the boxer.

In decisions involving good and evil, the choice finally rests with the person who not only acts but should also own up responsibility for his actions. Ultimately, it is the choice that matters – not your opinion.


Update: Neurologists have figured out a new way to get around with people who are in what is called the Minimally Conscious State (MCS). This appears to be the latest label that PVS has been morphed into. Affected patients are awake but make unreliable attempts to communicate.

In assuming that consciousness is wakefulness, they used a new method called Deep Brain Stimulation (DBS) – through which electrodes implanted in dysfunctional parts of the brain send electrical pulses to rejuvenate damaged neurons. Quite a procedure that is said to help heal the impaired brain functions like tremors. DBS is a sort of “brain pacemaker” helping restore the normal electrical pulses across neurons. Through DBS, someone in MCS woke up after 6-year-long slumber. This could spike his undamaged language regions in brain to speak again and he could even control his limbs. Quite a restart, by neurological standards.

So what does this mean? How can we prefer euthanasia, knowing that in the future some breakthrough can get round them? It mayn’t bounce them back, but still improve their condition. It’s quite tricky. So, I prefer the democratic consent of those in the patient’s immediate family – for deciding the course of action. Of course, if my argument matters.

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