November 17, 2010
Ethical and Bio-medical End of Life Issues
Nancy J. Duff
Associate Professor of Christian Ethics
Princeton Theological Seminary
Minutes of the Tenth Meeting of the 69th Year
The invocation was led by Donald B. Edwards. The minutes of the previous meeting were read by Paul B. Mott, Jr.
Five guests were introduced: André Yokana presented Frances Yokana and Janice Pell; Owen Leach presented Joel Greenberg; Donald Edwards presented Sally Edwards; and Nicholas Van Dyke presented Marcia Van Dyke.
There were 103 members in attendance.
John P. Schmidt presented seven nominees for membership: Judith Applegate, Nancy Beck, Marguerite D’Amico, John Heins, Robert Kuser, Anton Lahnston, and Guy Woelk. All seven were elected to membership and will be invited to attend the meeting of December 1, 2010.
Nicholas Van Dyke introduced the speaker, Nancy J. Duff, who is Associate Professor of Christian Ethics at Princeton Theological Seminary and a member of the medical ethics council of the Princeton HealthCare System. Professor Duff’s topic was “Ethical and Bio-Medical End-of-Life Issues.” To say that her topic is of more than passing interest to members of the Old Guard is an understatement, at least.
Professor Duff began her talk by focusing on some important cases involving withdrawal of care, especially the controversial and highly politicized case of Terri Schiavo, who collapsed at home in 1990 and endured fifteen years of living in a permanent vegetative state. When her feeding tube was finally removed for the third time, she died thirteen days later.
Professor Duff clarified what is meant by “permanent vegetative state,” which is a condition when only the brain stem functions. This is disconcerting and widely misunderstood, since some of the most basic indicators of bodily life, such as a heartbeat, continue to be present, while the upper portion of the brain no longer functions at all. Those basic bodily functions, however, usually require mechanical support of some kind, such as a respirator or feeding tube. The decision to cease such support is agonizing, and gives rise not only to feelings of guilt on the part of the decision-maker, but frequently leads to very destructive quarrels among family members and friends of the patient. In Terri Schiavo’s case, her husband’s effort to end such treatment led to an astonishing legal battle, where judicial decisions were appealed six times to the U.S. Supreme Court, which refused to hear the case, and to intervention by Florida Governor Jeb Bush, the U.S. Congress, and President George W. Bush.
While the Schiavo case was an extreme one, it illuminates the fundamental ethical issues involved in end-of-life care, the most important of which are these: Who decides when to withdraw life support systems? What are ethically acceptable criteria for making and carrying out such a decision? While Professor Duff made it clear that her position is thoroughly embedded in her understanding of her Christian faith and its ethical demands, she expressed it in secular language that invited people of all faiths or no faith to make decisions about the inevitable end of his or her life. She believes that the responsibility for those decisions should rest with the individual most directly involved — you.
Professor Duff was an eloquent advocate for preparing a living will or advanced directive setting forth your wishes should you become disabled and unable to speak for yourself. Your living will should name a surrogate who knows you well, with whom you have discussed the issues important to you. Professor Duff suggested strongly that you talk to your surrogate, especially about the guilt associated with ending treatment and life support. She also suggested that you name a single surrogate, with a substitute who will act in case your first choice becomes unavailable. Your living will should be in writing, and should include a clause denying a surrogate the power to do anything contradictory to the wishes expressed in the document. Finally, you should review your living will regularly and update it frequently, especially if there has been a major change in your life.
Professor Duff went on to discuss the ethics of a decision to remove life support. Her first point concerned the problem of suffering, which can reach horrendous levels. Should someone be “condemned to live” in those circumstances? At this point, her Christian faith became most visible: Human life is not just an animated body, she said. To deny this is a form of idolatry. Given the inevitability of death, we must accept the fact that “ready or not, my time to die has arrived.”
But we are confronted with serious dilemmas arising in part from our contradictory cultural attitudes towards death and in part from the enormous strides in medical science made during recent decades. While our culture is saturated with images of death, we are also committed to denial of its personal inevitability. Death is the enemy to be fought with every resource at our disposal. Furthermore, the Judeo-Christian tradition insists that each individual life is uniquely valuable. Nevertheless, Professor Duff insists that bodily life does not have absolute value. Only God is absolute. Indeed, she supports assisted suicide in cases of great suffering. Allowing horrendous suffering is not just cruel; it is exploitation of the suffering person.
It is at this point in end-of-life decision making that we are confronted with a slippery slope of ethical danger. We know of cases where treatment has been denied, for example, on racial grounds, and we know that fears that a doctor may want to harvest organs for a patient whose life is considered more valuable have had some basis in fact. Thus Professor Duff insisted that reluctance to withdraw life support is entirely appropriate, even necessary in order to avoid “playing God” in the worst sense of the phrase. She reminded us, though, that to deny that someone is dying, and to imagine that we can prevent all death by applying our mechanical or chemical remedies, is also “playing God.”
In summary, and in response to questions from members, Professor Duff reiterated the importance of understanding the concept of futile care, of preparing advance directives and selecting a surrogate decision-maker willing to follow the patient’s instructions. She believes in the importance of respecting a person’s right to die. In certain well-considered circumstances, she also believes that assisted suicide is ethically defensible. But in a great many cases, allowing natural death is the most ethically sound decision.
Respectfully submitted,
Patricia H. Marks
Five guests were introduced: André Yokana presented Frances Yokana and Janice Pell; Owen Leach presented Joel Greenberg; Donald Edwards presented Sally Edwards; and Nicholas Van Dyke presented Marcia Van Dyke.
There were 103 members in attendance.
John P. Schmidt presented seven nominees for membership: Judith Applegate, Nancy Beck, Marguerite D’Amico, John Heins, Robert Kuser, Anton Lahnston, and Guy Woelk. All seven were elected to membership and will be invited to attend the meeting of December 1, 2010.
Nicholas Van Dyke introduced the speaker, Nancy J. Duff, who is Associate Professor of Christian Ethics at Princeton Theological Seminary and a member of the medical ethics council of the Princeton HealthCare System. Professor Duff’s topic was “Ethical and Bio-Medical End-of-Life Issues.” To say that her topic is of more than passing interest to members of the Old Guard is an understatement, at least.
Professor Duff began her talk by focusing on some important cases involving withdrawal of care, especially the controversial and highly politicized case of Terri Schiavo, who collapsed at home in 1990 and endured fifteen years of living in a permanent vegetative state. When her feeding tube was finally removed for the third time, she died thirteen days later.
Professor Duff clarified what is meant by “permanent vegetative state,” which is a condition when only the brain stem functions. This is disconcerting and widely misunderstood, since some of the most basic indicators of bodily life, such as a heartbeat, continue to be present, while the upper portion of the brain no longer functions at all. Those basic bodily functions, however, usually require mechanical support of some kind, such as a respirator or feeding tube. The decision to cease such support is agonizing, and gives rise not only to feelings of guilt on the part of the decision-maker, but frequently leads to very destructive quarrels among family members and friends of the patient. In Terri Schiavo’s case, her husband’s effort to end such treatment led to an astonishing legal battle, where judicial decisions were appealed six times to the U.S. Supreme Court, which refused to hear the case, and to intervention by Florida Governor Jeb Bush, the U.S. Congress, and President George W. Bush.
While the Schiavo case was an extreme one, it illuminates the fundamental ethical issues involved in end-of-life care, the most important of which are these: Who decides when to withdraw life support systems? What are ethically acceptable criteria for making and carrying out such a decision? While Professor Duff made it clear that her position is thoroughly embedded in her understanding of her Christian faith and its ethical demands, she expressed it in secular language that invited people of all faiths or no faith to make decisions about the inevitable end of his or her life. She believes that the responsibility for those decisions should rest with the individual most directly involved — you.
Professor Duff was an eloquent advocate for preparing a living will or advanced directive setting forth your wishes should you become disabled and unable to speak for yourself. Your living will should name a surrogate who knows you well, with whom you have discussed the issues important to you. Professor Duff suggested strongly that you talk to your surrogate, especially about the guilt associated with ending treatment and life support. She also suggested that you name a single surrogate, with a substitute who will act in case your first choice becomes unavailable. Your living will should be in writing, and should include a clause denying a surrogate the power to do anything contradictory to the wishes expressed in the document. Finally, you should review your living will regularly and update it frequently, especially if there has been a major change in your life.
Professor Duff went on to discuss the ethics of a decision to remove life support. Her first point concerned the problem of suffering, which can reach horrendous levels. Should someone be “condemned to live” in those circumstances? At this point, her Christian faith became most visible: Human life is not just an animated body, she said. To deny this is a form of idolatry. Given the inevitability of death, we must accept the fact that “ready or not, my time to die has arrived.”
But we are confronted with serious dilemmas arising in part from our contradictory cultural attitudes towards death and in part from the enormous strides in medical science made during recent decades. While our culture is saturated with images of death, we are also committed to denial of its personal inevitability. Death is the enemy to be fought with every resource at our disposal. Furthermore, the Judeo-Christian tradition insists that each individual life is uniquely valuable. Nevertheless, Professor Duff insists that bodily life does not have absolute value. Only God is absolute. Indeed, she supports assisted suicide in cases of great suffering. Allowing horrendous suffering is not just cruel; it is exploitation of the suffering person.
It is at this point in end-of-life decision making that we are confronted with a slippery slope of ethical danger. We know of cases where treatment has been denied, for example, on racial grounds, and we know that fears that a doctor may want to harvest organs for a patient whose life is considered more valuable have had some basis in fact. Thus Professor Duff insisted that reluctance to withdraw life support is entirely appropriate, even necessary in order to avoid “playing God” in the worst sense of the phrase. She reminded us, though, that to deny that someone is dying, and to imagine that we can prevent all death by applying our mechanical or chemical remedies, is also “playing God.”
In summary, and in response to questions from members, Professor Duff reiterated the importance of understanding the concept of futile care, of preparing advance directives and selecting a surrogate decision-maker willing to follow the patient’s instructions. She believes in the importance of respecting a person’s right to die. In certain well-considered circumstances, she also believes that assisted suicide is ethically defensible. But in a great many cases, allowing natural death is the most ethically sound decision.
Respectfully submitted,
Patricia H. Marks