Man and the value of life; #3 (Reel 2)

Paul Tillich has stated the person is a moral concept. Pointing to a being which we are asked to respect as the bearer of a dignity equal to our own and which we are not permitted to use as a means for a purpose because it is purpose in itself. Each person as Dr. De Bono pointed out is unique. So while general laws respecting any aspect of medical care can state principles and values for all mankind yet actual decisions are always made in relation to this particular patient occupying the third bed on the left in Ward B the physician is called to deal with this particular life in a

one to one relationship. So we had a person in the position dealing with a person in the patient. And as a theologian I have deep concern for both persons and the decisions which each must make in the face of a crisis. This may sound gratuitous but in the OF then that the patient cannot share in the decision. Then I have the greatest respect for the physician who is called to make the ultimate decision voice of this patient as a person. Yes I have the greatest confidence in his personal integrity which demands in certain situations the acceptance of the burden of initiative about ultimate issues. Now let us turn to

some of the issues confronting us today. The first under discussion is raised by the availability of transplants or spare parts to a person. Here we are discussing the replacement of defective by the organs of the human body. Now obviously at least not in the presence of Dr. DeBakey. It is not my place to discuss the techniques involved but to raise possibly some of the issues in this area of great promise in the present and the future to begin with the most optimistic prognosis. If the transplant or replacement promises the possibility of a fuller and longer life OB and service to others. Then theologically speaking it can be considered a good thing.

For me it is help and not the preservation or the lengthening of life per se that is the ultimate end and purpose of God for each person. Birth help and death are a continuum of life and for the Christian life with a capital L as has already been pointed out begun in this biological experience and continuing beyond biological death is our concern. However if the operation is not an open and shut situation and if risk is involved for the patient then we are confronted with a whole new set of questions whose shares in the decision making process what consents are necessary if the risk is great.

Could this be classified as risk euthanasia. Now these questions directly involve the person but there are still other rules involving persons other persons in the social order. If the cost is so great that it must be supplemented by public subsidies does this person have a right to deprive other person of public monies which might be used for a greater good for a greater number of persons. If the transplant is limited in quantity. Who decides between persons on what criteria. If the only source is cadavers. Is pressure being brought to bear on grieving kin. Is the demand for parks raising questions of the violation of the dignity of

death or about death itself. I conclude the section with the affirmation that although life is sacred a gift of God and to be meaningful it is still not the summum bonum the absolute good. For if the sanctity were in life then the martyrs would be all wrong. Those who give away their lives were others would be wrong. Transplants cannot be justified solely on the grounds of the sacredness of life or simply as a way of gaining longevity or of instant immortality but only to re store health in a person for service. This brings us to the second issue namely mechanical assistance to

respiration and heart action. Artificial feeding and other medical advances to forestall the death of a person and it leads into an area of deep concern for all who are called to minister to the dying physicians nurses clergy and family. In our own family we had an experience a few years ago that was deeply disturbing to my wife particularly as she stayed close by all through it because the experience exemplifies in a personal dynamic way. So much of what we are discussing here today. I asked her to write out an account of what happened what her reactions were and what comments she as a

layman might make about the situation. What follows is in her words this concerns an 81 year old relative who had been diabetic for 20 years and in whom Cheerios sclerosis was an increasing serious problem. At the time of her last illness she had become very sentimental could no longer read watch television feed herself properly dress herself take care of her toilet needs or carry on a meaningful conversation. She was living in a church home for retired people and received beautiful and loving care from people who understood her problems. But one day she had a stroke and was rushed to the hospital and put a mediately in the intensive care section an hour later we were told what had happened. When we

arrived at the hospital we found her with nine to bleeding in and out of her body and a huge board beside her taking off heart beat and pulse. You doctors know better than I. All that was being done this relative was unable to speak and was semi conscious but the tubes bothered her and she kept trying to pull them out and so her arms were bound to the sides of the bed. She thrashed back and forth and it was amazing that in her weakness she could show such great strength as she tried to get free. The wild look in her eyes was almost more than I could bear. I went to the interne and said Are you committed to do this.

Can't you make her as comfortable as possible and let her go. If you save her life by these supreme efforts it will be tragic. There is nothing left there. But for eight days she had intensive care. Her heart kept beating and then mercifully she died. Here are points I would like to make about this. So I felt I should be grateful that the latest medical techniques were being applied. On the contrary To me the whole thing seemed cruel and barbaric. There was no peace or dignity to these last days. Second when a person 81 is said I will do such a degree that she is dependent upon others for all her physical needs no longer enjoys or is able to take part in life around

her. It seems absolutely wrong and cruel to prolong this life when a dying time is at hand. I think there should have been an immediate conference between the doctor who cared for her and knew her and her relatives. We could have told the doctor too that several years before the relative had said this every night when I go to bed I pray that I won't wake up. She was reading the humane loving thing would have been to move this poor tortured soul out of the intensive care unit and to a room where she could have been given gentle care that would have made those last days as easy and peaceful as possible. Let her go. There has to be a cut off point decided on. And in many cases the line would be hard to draw. As a layman I would say under the age of

65 maybe. All efforts to preserve life should be made except in unusual circumstances such as drowning for instance where there has been such delay in resuscitation that extensive brain damage is inevitable or a brain injury due to accident where the patient has lain for months without regaining consciousness. In most cases where a person still has responsibilities in life to fulfill minor children etc is in full possession of his senses and was physically able to lead a meaningful life until the time of his illness. Then do everything possible to keep that life going for after a certain age is reached. Death does not seem like an enemy. Too many children are grown and independent some measure of financial

security has hopefully been reached retirement age has come. Looking ahead these people dread the prospect of becoming a burden to those they love. They want to live in help but the thought of prolonged illness that makes burdens on them cannot be borne. Why cannot people who have reached this point in life say 65 or more or less be able to do this in writing. Register with their doctor and in writing register for safe keeping with near relatives. Some such statement as this. In case of severe illness I do not wish to have extraordinary means used to save my life. I am ready when my time comes to go. Such a statement would be binding on doctor and family in case of old age impaired senses and severe illness. If a patient had not given the doctor and family the

release before hand then together they should be able to decide if extreme measures should or should not be applied by it cost Medicare some $900 to prolong this life for one extra week in view of the circumstances. It seems almost dishonest to have incurred such great expense. Was it justified. I hear my wife's account and comments and euthanasia. I know this is not what we sought but rather what Dr Joseph Pletcher terms anti this than Asia. That is omission of something that might prolong life and thus allow a person or a body to die. This in contrast to

euthanasia the deliberate easing into death of a patient suffering from a painful and fatal disease. I find Dr. Fletcher's treatment of this whole subject as set forth in his book morals and medicine extremely helpful and commended to you as a well-documented text in this area as well as in other areas of medical care involving moral questions. And I have made many of his thoughts my own. First I would raise with you the question that seems to be hang up that issuing out of the logical contradiction at the heart of the Hippocratic Oath. The contradiction is there because the oath entails two things. First to relieve suffering and second to prolong and pro tect life. But when a patient is in the grip of an

agonizing and fatal disease these two concerns are incompatible. So to a layman it would seem that the two duties do come into conflict to prolong life is to violate the promise to relieve pain to relieve pain is to violate the promise to prolong and protect life. The theologian has problems with this since the oath makes the patients well they are the summum bonum not his life or biologic continuance. And it is as least at least arguable that the patient's welfare sometimes might include induced or at least accepted death. That you may know that this is not purely an eccentric concept. I point to the fact that model theologians who advise the Vatican

are universally agreed that no direct action to end a life may ever be taken. But various people elocution Zz have said that ethically it is right and proper in some cases to omit unusual and extraordinary measures and let the patient go. Now I recognize that there are many questions that haunt the medical profession in this area. What is considered heroic today may be ordinary tomorrow. One of those cases where new insights seemingly miraculously result in remission or cure could failure to sustain life constitute murder. What is legal liability. Who am I to play God. But isn't prolonging death or letting it go playing God. I imagine that it is

never easy to make the ultimate decision. I could only make it on the basis of my read God called up a person of my patients when I was convinced either through the flatness of his electrocardiogram pick tracing over a specific span of time or on the assurance of a position that there was every indication that era breast Sobel damage had been done to the brain so that personality had gone. I could then share the decision with him in clear conscience that the issue was no longer one of life or death but rather of which kind of death and agonized or a peaceful one more than a century ago. Arthur Hugh Clough wrote with bitter irony Thou shalt not kill but needs not strive oafish

a sleeve to keep alive persons ought to be able to die with dignity. Second the for the question of when is a man dead is becoming more and more difficult to answer precisely. I understand that the determination of death. Of Life And Death has traditionally involved the three factors of respiration heart beat or pulsation and brain function. Now it would seem that more and more authorities state that a person should be considered dead when his electrocardiogram pick tracing is flat for a specific period implying that respiration and pulsation do not in themselves constitute evidence of life. I understand that a committee of the American Law Institute is giving serious attention to the question of when a person is to be

considered legally dead. Further I note that in May 1066 by unanimous decision the French National Academy of Medicine decided that a man whose heart is still beating may be ruled dead. The Academy the Academy's decision which was based on the report of a special commission set up for months before has the effect of permitting doctors to remove living organs for transplantation purposes from people who have no hope of survival. And it recommended that the Denise should not should be confined confirmed excuse me by the electro and sefl a graph. If the brain shows no activity for forty eight hours the brain and the patient them are assumed to be dead. But these attempts to define death do not help a doctor with a patient part of whose

brain is functioning or with a slow dying patient who may be revived many times. I have already referred to the papal pronouncement of November one thousand fifty seven. Pope Pius the 12 concerning the suspension of extraordinary means of prolonging life but which does not define extraordinary in the same vein an Archbishop of Canterbury agreed that. Cases arise in which some means of shortening life may be justified. It should be noted that both of these church leaders of the recent past preferred to leave the decision as to when in the physician's hands Dr. Jacoby of its chief rabbi of the British Commonwealth says the Judaism emphatically denies the right of a doctor to let his patient die in peace. Since it derives its sanction from the Biblical Daal shalt surely cause him to be healed. But then he

qualifies this admirably clear statement by adding that Jewish law does not require the position to prolong the patient's misery by artificial means but artificial remains undefined. It would seem to me that a team of doctors lawyers philosophers and theologians should be a stablished to work out a definition of death. Because the public is becoming increasingly concerned that a newspaper account of a few weeks ago reported that whereas many years ago people feared being buried alive. They now fear being pronounced dead before their time. For the sake of transplants as a matter of fact it would seem important to establish procedures and mediately to deal creatively with the social and socio psychological factors thrust upon physicians and surgeons through the emerging

biological revolution as all of how analyst Dr Rene de both states in man adapting the power of positions over life and death. Has become so great that medicine can no longer be considered apart from social philosophy. He goes on. Unfortunately while the scientific method is a mentally affective for dealing with the. Technical aspects of Biomedical Problems it provides no philosophical basis or ethical guidance for relating technical solutions to the fundamental needs or aspirations of man. This leads into my concluding thought that one given a magnificent technological advances that have been made in the field of biology and with the promise of even greater advances which will enable physicians to sustain health through the application of this new knowledge thus enabling man to live longer in fulfillment of His purpose in life

and to given the theological and religious perspective that it is the person who is important. I believe that we are called now today to establish in every community as is the case in a few councils that represent the balanced judgment of sociologists psychiatrists lawyers ministers who will assist physicians in establishing criteria what he terming the who and when of patients becoming benefactors of the miracles of our day. Although it may well be that the ultimate decision will be made by the opposition on a one to one basis. Nevertheless help should be made available to the physician in determining such matters as who shall receive transplants or the advantages of sustaining life through other means or in determining the time of death

or in decisions relative to sustaining. Dying or living. From my perspective if we are to deal with the whole man then theologians must become responsible involved. Finally to return to my starting point. As important as these interdisciplinary dialogues are in a stablish ng criteria and guidelines for the assistance of the physician. Let us. Always remember that it is the person who is first last and always the subject of our concern. The person created in the image of God to love his neighbor as himself and whose purpose in life is revealed and found in service to his fellow man. He is the subject of our concern from birth through death.

Of the. You've been listening to the Right Reverend Roger W. Blanchard bishop of the Episcopal Diocese of southern Ohio as he offered a religious perspective on the subject of man and life earlier in the program. We heard Dr. Michael DeBakey well-known heart transplant surgeon from the Baylor University College of Medicine. These lectures were part of a man and value of life symposium sponsored by the University of Cincinnati College of Medicine as one of the special programs highlighting the university's sesquicentennial celebration. Next week we present a legal perspective of man and the value of life as viewed by the Honorable David L. basil and chief judge of the U.S. Court of Appeals in Washington D.C.. These programs were produced at the University of Cincinnati station WAGA U.S. and were distributed by the national educational radio network.