LCMS Convention Workbook St. Louis, Missouri — 1981, Page 405

Transcription machine transcription, uncorrected

⤓ Download .txt · copy text

THEOLOGICAL DOCUMENTS

the contemporary and necessary attempts to redefine death, therefore, will be
considered after some general statements on life have been set forth.
a. Life

There is a sense in which life, partly because it is God’s creation, defies
definition. There are dimensions and depths to lving that can never be
captured in any verbai formulation. Yet, in a study of this kind, certain defi-
nitions need to be set forth, if for no other reason than that they help to
provide some general guidance for persons who deal in matters of life and
death.

Life, for example, has been described as vitality. It is a state of existence
characterized by active metabolism. Vegetive life, by way of distinction, is the
simple metabolic and reproductive activity of a human being apart from the
exercise of conscious mental or psychic processes.

Usually it is the fear of existing in a state of vegetive life that moves people to
think of euthanasia as a way of abruptly ending a state of being devoid of
conscious mental or psychic processes. In the fall of 1976 the State of Cali-
fomia enacted legislation known as ‘The Living WilL”’ This is a written, docu-
mented and witnessed instruction to the family or heirs of an individual that no
extraordinary efforts be used to resuscitate or reestablish his or her respiration
or heartbeat in case he or she is afflicted with an apparently fatal and terminal
disease. Such a document, certified at a time when the person involved is
presumed to be of sound mind, does not request destruction or killing
Instead, it constitutes a request that good medical judgment be exercised. It
does not abjure the use of compassionate care and treatment. Euthanasia is
not at issue in such cases, for no deliberate atternpt to hasten death is
involved. It is a matter of providing instruction not to undertake heroic or
extraordinary measures in order to sustain some semblance of life.

It is not only a privilege but a duty for Christians to render every possible
measure of care and compassion. It need not be extraordinary care, for heroic
therapy can also kill despite the good will that may be manifested in such
efforts. The medical profession is committed to precise and sensible care
based on sound principles and on the considered judgment of the physicians
handling a particular case. The patient cannot, asa rule, be consulted because
of the great confusion and disorientation resulting from the effects of both the
disease and the medication. The relatives need to be informed, but the
request of the physician must always be that the patient be given the oppor-
tunity to receive that measure of care which, in the doctor's judgment, will give
comfort and may provide a cure without jeopardy or the application of heroic
efforts.

In order to provide a glimpse into the mysterious dimensions of life and in
order to illustrate the kinds of considerations which persons involved in the
administration of medical care must give, it may be helpful to look at a few
examples of patients in various age groups and with different medical prob-
lems.

12

of a 10 percent probability, to “give it a try" under careful monitoring in an
attempt to achieve relief and to restore a functioning individual?

Let us assume that therapy is administered. Blood may be given to strengthen
the patient. Fhuids can be added to combat the thirst and dry membranes of
the mouth and nose, nutrition may be offered and every effort will be made to
sustain kidney function, which is one of the systems which must be kept alive
for a person to live. Monitoring indicates that the therapy (chemotherapy,
cobalt or radium) has had detrimental effects on the bone marrow as weil as
on the blood formation and upon the general physical status of the patient and
that there has been no progressive reduction in the growth of the cancer. It
needs to be rernembered that this patient has been inoperable from the
outset.

{s it necessary to give a detailed explanation of the hopelessness and the
hazard of the continuation of this therapy to the patient? The bone marrow
and, therefore, the blood, has been depressed not only by the disease but also
by the drug Therapy, if continued, would kill the person. Blood cannot acti-
vate and rebuild the bone marrow because of Its destruction by disease and by
drugs. Therefore medical judgment indicates that therapy must be stopped.
Where possible the physician may obtain from the patient a cooperative deci-
sion that such therapy should be initiated which will be best for him, but it will
not be in the category of ‘above and beyond the call of duty.” It will be given
for compassionate care and for patient comfort. Fluids will be administered to
make the patient more comfortable and to alleviate suffering. Oxygen may be
given, not in order to add to the length of the Efe, but to give the patient
comtort in his seriously tragic plight. If the patient has no control of the bowels,
nursing care will see to it that he or she is kept clean and does not have the
unfortunate, painful experience of bed sores or 8 soiled bed. The patient ts
moved from side to side.

In sucha situation medication ts given for comfort, not for killing. Medication is
administered to reduce pain and to permit the patient to sleep. The physician's
approach must be based upon the knowledge of the patient and the desire to
give accurate and compassionate care. The removal of certain drugs is not a
Thatter of encouraging what some want to call passive euthanasia. Instead, it
emphasizes the care given an individual as a result of sound judgment and
medical experience.

iv. Brain Damage. A patient who has suffered brain damage but who possesses a
spontaneously beating heart, active circulation, active respirations, and who
produces urinary output must be sustained and observed caretully while
monitoring determines whether other systems are involved or become
involved with the consequence that total death ensues. Anyone who has been
a physician long enough will have had the experience of seeing a patient,
comatose and morbid on admission to the hospital, being discharged in a
wheelchair, mentally alert with a smile on his or her face, waving good-bye,
and invoking God's blessing. The processes of life and living are that myste-
nous.

b. Death

The usual dictionaries, including Dorland’s Medica! Dictionary, define
death as: (1) “the cessation of life”; (2) “‘the cessation of all vital functions
without capability of resuscitation, either in animals or plants."’ The American

14

i. Start Birth. An infant is born with an APGAR rating of 2 (a rating of 10 indi-
cates that an infant is fully responsive, with all systems functioning and consid-
ered normal). The figure 2 indicates difficulty with breathing. abnormal color
because of lack of oxygen. flaccid muscles, limpness, and lack of movement.
In such a situation the attending physician is faced with the problem of resus-
citation: the administration of oxygen. stimulation and the clearing of the
airways. Generally speaking such a baby. if these steps of resuscitation are
taken and if the infant is at term. will respond and cry.

Will this baby be normal? Will it be retarded? These are questions that the
physician faces. What should the reaction of the physician be? A heart is
beating. There are gasps of respiration. There is some evidence of life in most
systems but not in all. The life that is present is not strong. Some of these
infants have developed into exceptionally brilliant individuals. Less than 1
percent have a stigma attached by such an experience at birth. but it is also
possible that paralysis or mental retardation may result

After a careful and complete evaluation of the infant, is it the doctor's obliga-
tion to discuss with the mother. if she is not anesthetized. or with the father. the
matter of making a decision as to whether he ought to withhold assistance
from this baby or make every attempt to provide the best possible medical
care to keep the baby alive? It should certainly be the latter. since in the
strange ways of God the baby concemed may become a useful member of
society or, by failing to develop fully. provide the occasion for others to exhibit
and bestow the kind of care which God's creatures deserve

i. Spina Bifida. This is a defect caused by the failure of the spinal column to form
normally. In a large number of such cases there is neurological damage which
may extend not only to the lower extremities but also affect the head and brain
with hydrocephalic conditions. Since a permanent incapacity could result. is
the proper procedure one of evaluating this infant and making the decision
that it be permitted to die? In an actual case. to have permitted such an infant
to die would have resulted in a great loss to the community. At delivery both
the pediatrician and the neurologist indicated that great hazards were involved
in performing corrective surgery. An infant who was hydrocephalic or para-
lyzed could have been the result. It was a case which might have resulted in
exciting rewards or serious regrets. In this particular case however. corrective
measures were taken and complete recovery occurred. This person, now a
college graduate and fully functional. has been of great assistance to many
people. Since many spina bifida babies will not be as greatly benefited by
treatment as in this specific case, it is important to remember that decisions
regarding procedures to be followed in such situations must always be based
on what appropriate care for the infant requires, not merely on what the
results of such treatment might be.

iii, Advanced Malignancy. What is the decision that should be made concerning a
patient with an extensive, far-reaching malignancy such as a carcinoma of the
ovary with metastases to the lung. the diaphragm and intestines? Let us
assume that this condition is found at the time of an operative evaluation. We
know that at times cancer will respond to modem chemotherapeutic agents.
but it is aiso rue that chemotherapy may be very reactive and difficult for the
patent to tolerate. This is also tue of radiological, cobalt or radium therapy.
Should the decision be not to attempt this additional! therapy or. on the basis

13

Medical Association says that ‘‘death shall be determined by the clinical judg-
ment of the physician using the necessary available and currently accepted
ctiteria.””

In this connection it should be noted that in some circles a new criterion for
death is being used in medicine today. It is called irreversible coma or brain
death and is determined by the following criteria: (1) unreceptivity and unre-
sponsitivity, (2) no movements or breathing, (3) no reflexes; and (4) flat elec-
troencephalogram (brain-wave test). However, even in the case of the appli-
cation of these criteria, tt is not possible to be fully certain at all times that a
patient is dead. Their validity, for example, is dependent on the excfusion of
the following two conditions: hypothermia (that is, temperature below 90
degrees Fahrenheit, or 32.2 degrees Centigrade) and central nervous systems
depressants such as barbituates.

It is clear that euthanasia as the practice of deliberately ending life where
some small possibility for continued existence still remains is killing, for total
destruction is imposed from without on all body systems. These include the
brain, the cerebral and neurological systems, the heart, the circulatory systern,
the kidneys, the excretory system, the liver, the detoxification system, and
thus the entire metabolic system. In many instances recovery and rehabilita-
tion can take place as a result of the administration of ordinary care, given for
comfort and cleanliness.

3. Ordinary and Extraordinary Means

Some attention must be given to the distinction currently made between
ordinary and extraordinary (or heroic) means of preserving life, for the differ-
ence between them throws some helpful light on very difficult aspects of the
issue known as euthanasia.

Ordinary means are usually described as those measures which can be
taken on the basis of the judgment that there is a demonstrable or recogniz-
able proportion between the good effect sought and the degree of hurt or
hardship involved in their use. They comprise all the help a patient can obtain
and undergo without imposing an excessive burden on himself and others.
They are considered to be imperative for the sustaining of life and are not,
therefore, refusable.

By way of distinction, extraordinary treatment refers to the use of artificial
means to prolong a patient's life once his vital processes have ceased their
spontaneous functions. Furthermore, this term also embraces those measures
which are very dangerous, difficult, painful or even costly, whose good effects
are not deemed to be proportionate to the difficulty and inconvenience
involved. They may, therefore, be refused. There are four major factors to be
taken into consideration in extraordinary cases:

(a) When irreversibility is established by more than one physician;

(b) When a moment in the process of dying has been reached where noth-

ing remains for medical scence to do except to offer proper care;

15

405