We've turned death into an enemy. Consequently,...


We've turned death into an enemy. Consequently, we overlook the fact that through much of history people worried not so much whether they could defeat death as how well they would meet that fateful moment.

But the assumption that any effort to postpone death is inherently worthwhile is taking a heavy toll in hospitals throughout the country, a toll that can be as harsh on families as on the patients themselves.

The Rev. Edwin Schell, a United Methodist clergyman here, raises an issue that needs more serious discussion by physicians and their patients -- in other words, all of us. That issue is the ethical ramifications of prolonged efforts at resuscitation, either at an accident scene or in a medical care facility.

Schell points out that medical advances create a situation in which people now face more than the age-old questions about how and when we are going to die. Now we also must wonder, "How many times?"

Resuscitation techniques can produce miracles in restoring breath and warmth to seemingly lifeless bodies. But these efforts can also produce tragedies, as Schell has witnessed firsthand.

"In my ministry a number of cases stand out where overruling God by resuscitation had ethical implications," he wrote recently in the Maryland Academy of Family Physicians News Bulletin.

One such case involved a boy struck by a vehicle who survived 18 years in a persistent vegetative state. "His family was torn apart by the tragedy (his father too distraught to visit)," Schell writes. "The driver who struck him was also decimated. In retrospect, had the original prognosis that Louis 'would not live the night' been allowed to prevail, it would have spared all concerned much grief and suffering."

Yet there are reasons that strenuous, even unreasonable efforts are often made to keep vital signs flickering, regardless of the suffering of the patient or the prospects for returning to consciousness.

One is evident in the story Schell passed along to me of a hospital chaplain trying to minister to a man who has told physicians that if his comatose father dies, he'll sue them.

Another reason is the faith in that small, one-in-a-million chance that this case will produce a miracle.

That kind of faith is admirable, and it is necessary in medicine. Yet it's important to recognize that there's a point where an admirable faith can transform itself into a stubborn resistance to reality on the part of patients, their families or even medical personnel.

In some ways, we've lost touch with our mortality. That's another way of saying that we've lost touch with who and what we are.

We're spared many of the fates that earlier generations met. But that doesn't mean we don't have to think about how we want to die.

Consider this letter from a Michigan woman:

"At the age of 61, I was diagnosed as a kidney failure patient and put on dialysis. ... The doctors in the renal unit want me to undergo painful tests and aggressive treatments for a possible colon malignancy that might be making me lose blood so fast. I want simply to have the dialysis treatments to take off fluids and to keep me from going into a coma. I just want to be kept comfortable. The doctors are even pressuring me to think about a transplant, and I am now 63 years old!

"I am shocked at the way doctors want to go to extremes to keep people like me alive. ... I just want my last days to be free from discomfort. ... This is no kind of life." -- J.H., Sault Ste. Marie, Mich.

Send your comments and questions about death and dying to Sara Engram, Mortal Matters, The Evening Sun, P.O. Box 1377, Baltimore, Md. 21278.

Universal Press Syndicate

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