This article explores sensitive topics and shares the author’s perspective at the time it was written. While some opinions may be strong or provocative, the intention was to foster thoughtful discussion and understanding. Also, opinions and phraseology may become more nuanced or even change with time, so consider this a snapshot.
A note for context:
This article was written as part of a college assignment for Advanced Composition and Critical Thinking where I was required to defend a position on a challenging, controversial topic. While the paper essentially reflects my views at that time, my experiences with personal loss and caregiving have broadened my understanding of this complex issue. Today, I approach these matters with more nuance, recognizing the deep ethical and personal dimensions involved. This essay should be viewed in the context of a structured academic argument rather than a comprehensive or final stance on this sensitive subject.
My homework for this week was to answer this question: “Currently, there is an ethical dilemma regarding terminally ill individuals and their right to die. Do you believe an individual has the right to die? Should medical professionals use extensive measures to prolong the life of a terminally ill patient? Does your opinion change if the patient is suffering from a chronic condition? Should there be a national right to die law?” The following was my response to this thorny issue.
I believe individuals should have the right to make decisions about their lives, as long as those choices do not harm others. Harm includes physical, mental, emotional, spiritual, financial, or criminal damage to people, animals, and the environment—land, air, water, and plants.
Personal autonomy is essential—the right to make decisions about one’s own life, including whether to seek or refuse medical interventions. This includes end-of-life decisions when faced with terminal illness or severe suffering. However, I recognize that these decisions are fraught with ethical challenges that must be carefully considered. For example, at what point does caring for someone with a chronic condition turn into harmful, prolonged torture? I doubt any law could satisfy everyone, and any attempt at such a law must allow for exceptions.
From the moment they are born, people have the right to live. Benjamin Franklin stated that “in this world nothing can be said to be certain, except death and taxes” (Letter to Jean-Baptiste Leroy. November 13, 1789. Wikiquote/Benjamin_Franklin). Ideally, between birth and death, one’s life is filled with education, romance leading to love, possible procreation, some fulfilling work, charitable contributions to society, and also the formation of a personal value system. Nobody’s path through life is the same, thus no one’s personal value system develops identically. Every person feels a little differently about what is ethical and what is not.
Polling the population reveals the majority opinion on various topics. In a democratic society, the election process puts that possibility into practice. Yet, minority opinions are equally valid. What may seem outrageous to some can be an ethical choice given an individual’s unique personal value system.
Take the case of Kyla, a vibrant, 44-year-old educated linguistics professor, who ends up in a bicycle accident resulting in full-body paralysis and the loss of speech. She has to stay on a ventilator to breathe. While she may not be able to express verbally her utter despair in words to her loving husband, he can see the pain in her soul. The doctors have informed the husband that Kyla will never regain her speech, leave her hospital bed, or be removed from the ventilator, but she is otherwise in remarkably healthy condition and should “live” for many years to come.
Is that really living? When every passion you love in life is denied to you, can that really be considered living? When a machine keeps your body in a state of artificially maintained life, is that life?
In my view, Kyla’s quality of life ended with the accident, even though her body continues to survive through medical intervention. Modern medicine can extend physical life, but I believe that a life without autonomy, joy, or the ability to pursue one’s passions is no longer truly living. Indeed, if it weren’t for modern medical advances, the professor would have stopped breathing and passed away shortly afterward.
Naturally, we want to help a person in need. We instinctively try to save lives whenever possible. Sometimes we fail, and the person dies anyway. Other times, we succeed, and the person recovers, becoming an inspiration to others. Christopher “Superman” Reeves was an excellent example of the second possibility. But the hypothetical professor represents a more tragic outcome. In this case, her body was saved, but the soul was lost.
Eloise, a tender soul of 72 years, has been wracked with pain from recurring bouts of leukemia for the past ten years. Her children and grandchildren have active, happy lives of their own, and she feels that she is becoming a burden on them. She knows that any chance of recovery will require more chemotherapy, radiation, and other harsh treatments. She is tired of it—tired of the pain, the treatments, and the toll it has taken on her family.
After years of fighting leukemia, she is ready to find peace, but current laws prevent her from choosing a dignified end on her terms. She wishes for a peaceful end to her suffering but cannot bear the thought of leaving her children with that grief. In cases like Eloise’s, where suffering is unrelenting and the patient has expressed a clear desire, I believe individuals should have the right to choose how and when to end their life with dignity.
If she passed away peacefully on a cruise surrounded by family, the doctor assisting her could face malpractice or even murder charges. Similarly, if Kyla’s husband from the first example had asked to deactivate his wife’s respirator, he might be harangued as uncaring, despite her wish not to live in such a condition. These legal and social pressures make a compassionate, dignified choice all the more difficult.
Death is the most final decision a person can make. Short of possibly reincarnation, there is no changing your mind after that decision is made. However, living out a lifetime in pain, as a “vegetable”, or in utter despair is biological life, but not really living. It can be torture. Torture can and should be prevented because it denies a person their dignity and value. It is inhumane to keep a person living in suffering.
In cases of severe, unrelenting suffering, some advocate for doctors to have the option, in carefully controlled circumstances, to provide their patients with choices about the end of life. This should never be done in a moment of extreme angst. Death should not come because of impulsive decisions or during times of acute emotional stress. Careful consideration and time should pass before such a decision is made.
Family members who decide to “pull the plug” should never be made to feel guilty for the decision. They already have made a tough decision, one they will have to live with for the rest of their lives. Supportive hospice nurses can help them with coming to terms with their grief and move on with their own lives.
Any law on this topic is sure to be controversial. A law facilitating thoughtful decision-making and ensuring continued insurance coverage throughout the decision-making process and eventual outcome, whatever that may be, would be highly beneficial, helping to reduce some of the financial considerations that families have to consider.
Too many options can lead to decision paralysis, making things more complicated. But not having enough considered and viable options leaves people feeling hopeless and without the autonomy they deserve in life and in death.
Update: In June 2012, my mother and I were put into this very situation. My father had successfully undergone open heart surgery, but early the next morning, he suffered a massive stroke. The details of that nightmare are posted elsewhere on this blog.
We were left in charge of my father’s welfare and had to make some of the worst decisions a family ever has to make: let him live or die?
My dad underwent this elective surgery because he wanted a chance at a better life. If he did not have the surgery, he would have slowly felt worse and worse, until he could do none of the things he loved, and within two years, he’d be dead anyway. As it was, his activities were already limited. He was unhappy with the life he had at that time. He wanted the time he had left to be better.
Prior to the surgery, we saw an estate attorney to draw up a family trust and wills. During the process, we clearly took a hard look at the possible outcomes, and what we each wanted to be done in case we couldn’t make that decision for ourselves. As a result, we knew that my father did not want to be a “vegetable”, stuck on life support, and just lingering on until his body finally failed. For one thing, that would be an impossible financial drain on the family, and, more importantly, he did not want to live a life worse than the one he was living then.
If we had been given a functional crystal ball that showed us the ultimate outcome of the surgery, my dad probably would have opted for the two extra years of life. However, he would never have opted for additional time if it meant being incapacitated.
For three weeks, his doctors gave us hope that they might be able to salvage him.
They wanted to insert a more permanent feeding tube and perform a procedure to insert a tube in his airway to hook him more permanently to a ventilator, greatly increasing the likelihood he would stay in this state long-term. We did not let them.
Some of the nurses looked at us as though we were being cruel to him. While these were ways to possibly make him more comfortable (and likely ease the nurses’ burden), such procedures would have left him dependent on machines, trapped in a netherworld of non-living.
From a legal standpoint, it was much easier to withhold “life-saving” treatments that would have prolonged his suffering than to “turn off the switch” once he was on them. We knew that if we caved in to pressure by those well-meaning medical professionals, we would be betraying my father’s wishes.
Finally, even his most optimistic doctor acknowledged he was beyond recovery. Even if he regained consciousness, he would be trapped—lingering on, bedridden, and unable to communicate. Worst of all, he might be aware that he was trapped so with no way to escape for years or even decades.
We instructed them to deactivate the pacemaker and respirator. His heart continued beating with a healthy, normal sinus rhythm—a testament to the surgery’s success. Yet, we were horrified, wondering if we had waited too long and condemned him to a fate worse than dying.
Fortunately, within six hours he began showing symptoms of pneumonia. Nurses again urged us to put him back on a respirator so he could breathe again. We remained steadfast and had him transitioned to palliative hospice care.
My mother and I take comfort from honoring my father’s wishes. Knowing what we know now, we would have deactivated the pacemaker immediately, sparing him the heroic measures. The stroke was too severe; there was no hope of returning him to his pre-surgery state. But we didn’t know.
While I appreciate many medical professionals’ desire to preserve his life at all costs, some staff made us feel guilty for not pursuing more aggressive treatment. We did our best to make decisions in line with what he would have wanted, even though it was an emotionally difficult path to take. While we had hoped for such a different outcome, at least we know that we did not make a huge mistake.
In the end, decisions about life and death are deeply personal and complex. Though ethical concerns exist, individuals, with the support of their families and doctors, should have the right to make end-of-life decisions based on their values and dignity. There are no easy answers, but respect for personal autonomy must be prioritized when confronting terminal illness and suffering.