If bioethics has central or recurring questions, this is
surely one of them. And, of course, the
problem, or question, often is restated to: who decides if this life is worth
living? The confounding elephant in the
room is that families often have more hope than care providers, and the
evidence is mixed on whether either party is particularly accurate in
projecting the future.
Arendt in her book The Human Condition described
in detail how humans must make choices without knowing outcomes. Everyone (except neurologists) loves the
stories about people coming out of comas and persistive vegetative states. Neurologists are not fans because it admits
to an inability to predict—even being right 98% of the time isn’t enough.
face this problem constantly, but with different stakes. We know fetal heart rate monitoring is far
from perfect, but none of us would ignore a bradycardia of several
minutes. Maybe this baby is actually
dying, and we aren’t going to take the chance.
When is non-existence acceptable in my specialty? Only when the pregnant woman has decided it
ends of life, non-existence, the ultimate existential question, is left to
patient and family values, because there is no cultural/societal
consensus. Inuit tribes expected the
elderly and infirm to walk out into the ice when times got tough, and food was
scarce. Our culture rejects this, but
medical students often question why we keep alive an individual with no hope of
recovery and little or no awareness of their surroundings or condition.
I am not a
utilitarian, and I am not defending any of Peter Singer’s views. But I still wish that we did not prolong
suffering, or pour resources into a life without awareness of its own
self. Families struggle with these
decisions, and often choose the conservative choice thinking that hope is
better than non-existence. Those of us
in medicine tasked with keeping these fragile physiological flames burning
often ask ourselves whether we are doing harm or good. Until we reach (if ever) a societal consensus,
we should share with decision makers our moral ambiguity and sense of regret
when we support their loved ones against our better judgment. Is this enough? Perhaps not, but we are not yet even doing
this with consistency.