Assaulted Woman to Be Kept Alive, Rules India Court

On March 7, India's Supreme Court decided a landmark case that will allow life support to be legally removed from some terminally ill patients. The ruling involved the case of a woman who has been in a vegetative state since she was sexually assaulted and suffered brain damage 37 years ago. Her parents are dead, and a friend wanted hospital staff to stop "force-feeding" her mashed-up food. While the court ruled that Aruna Shanbaug be kept on life support, it distinguished between "active euthanasia" and "passive euthanasia," allowing the latter for certain terminally ill patients.

Until I read these reports, I had never heard the phrase "passive euthanasia," let alone grappled with whether or not I participated in some such cruelty.

It was nearly 20 years ago. An elderly relative had been badly deteriorating in a residential care facility for a few years when she was hospitalized with congestive heart failure. She was initially conscious, but quickly lapsed into a coma. Tests showed she had minimal brain function. The doctor said she wouldn't recover. Although there was a medical directive in place that prohibited heroic measures, a feeding tube was inserted.

After a week or so, we were told the feeding tube had been removed because it had a kink in it. Everyone knew that if she went back to the nursing home with the tube, it would take a court order to remove it again. It was left to her family to decide what to do. The feeding tube was not reinserted. She was given intravenous fluids to keep her comfortable and she died a few days later.

Even if the hospital staff was lying about the kink in the tube and removed it of their own accord, I don't believe this was "passive euthanasia." I believe it was resisting, or correcting, medical encroachment.

I wonder now, though, if medicine will make murderers of us all.

In a 2010 talk at the Center for Bioethics and Human Dignity annual conference, Ryan Nash, M.D., an assistant professor at the University of Alabama School of Medicine Center for Palliative and Supportive Care, argued from the work of bioethicist Jeffrey Bishop that in the relatively new field of palliative medicine, death is not only being redefined from a biological standpoint, it is being redefined psychologically, socially, and spiritually.

Whereas the hospice movement sought to return death and dying to the community, Nash said specialists are now trying to control all aspects of death in pursuit of "optimal dying." He blamed this development in part on a redefinition of medicine from a discipline that sought to care, cure, and comfort to one that frames it as a duty to relieve suffering. Nash warned that such a duty could lead health-care professionals to believe that euthanasia and assisted suicide are encompassed within their responsibility because it isn't always possible to adequately relieve patients' suffering, especially their spiritual, psychological, and social pain.

At the same coference, Patrick T. Smith, assistant professor of theology and philosophy at Gordon-Conwell Theological Seminary and ethics coordinator at Angela Hospice Care Center in Livonia, Michigan, argued that any act, whether passive or active, that is intended to hasten the death of a patient is wrong from both a Judeo-Christian perspective and from the foundation of homicide law. He said discontinuing or refusing futile care is not wrong for those who are imminently, irretrievably dying, but noted that imminent death is not synonymous with terminal illness. Likewise, he said, refusing treatment that is burdensome is not the same as refusing life. When such treatment is withdrawn, an ethical health-care professional will immediately replace it with active comfort-only care that serves life not death. Smith concluded that comfort-only care stands between euthanasia and a vitalism that seeks to extend life at all costs.

From these descriptions, I am convinced that my instincts about my relative's death are correct. The Indian situation is not so clear. A representative from the hospital where Shanbaug lives told the Los Angeles Times that the staff is fond of her and that she smiles and has a preference for mangoes and fish. One can view her care as simultaneously burdensome, futile, and comforting. The stage was set for that dilemma a long time ago. (Indian commentators are likewise divided over the court's ruling.)

In a 2006 Los Angeles Times column, author Anne Lamott confessed to the kind of "totalizing" view of death that Nash described.

"The man I killed did not want to die, but he no longer felt he had much of a choice. He had gone from being tall and strapping, full of appetites and a brilliant manner of speech, to a skeleton, weak and full of messy needs," Lamott wrote of the suicide she assisted.

Her solution was to kill the body with a lethal dose of Seconal before it killed what she and her friend believed was his essential humanity. One can only assume Lamott didn't have the capacity to handle her unbelieving friend's spiritual and psycho-social needs. In expanding the definition of death to include mental incapacitation, she bifurcated body and spirit, which is ironic for a writer whose primary appeal is in her tendency to transgress artificial boundaries between sacred and secular, liberal and conservative. Here she merely transgressed the sixth commandment. Even atheists on the scene recognized that and urged her not to "play God."

In all three situations, a physical solution was sought for an existential problem, as if the world is only a material place. Few things in life are more painful than our inability to alleviate the suffering of those we love. As Christians, though, we are called to resist this kind of reductionism. Whether we are tempted to artificially extend life or prematurely end it, we must resist.