Before I Die: Medical Care and Personal Choices. - television program reviews

Commonweal, April 25, 1997 by Frank McConnell

Man has "invented death," wrote Yeats, and the poet was absolutely right: As the only animals who know that we will die, we are also the only animals subject to anxiety, hope, religion, and the future tense. (As Milan Kundera says, all the other animals still live in an eternal present - in Eden.) It's been suggested - and I believe it - that the birth of consciousness is really the birth of the consciousness of mortality. So you can invert Yeats's proposition: Death has invented Man.

At century's end, though, the fact of death has taken on an unprecedented and distressing complexity. As technology spreads ever wider its wings - angelic or demonic - we're less and less sure what death is, when it actually occurs, and, most frighteningly, when to declare it.

My dearest classmate from Notre Dame (1964) suffered a massive coronary on the streets of Oklahoma City eight years after graduation. Since he was from a family of millionaires, he was put on life support even though all brain functions had ceased. It was more than a decade later when I read that prayers were requested for his repose. In other words, somebody had finally pulled the plug, cut off the IV, pushed the OFF button. And this was humane? This was moral?

The Catholic position - and the position of most churches - is flexible about discontinuing "useless" medical intervention, but unalterably opposed to euthanasia. But how do you oppose euthanasia (Greek eu = "pleasant" thanatos = "death") when medicine, in its triumphant, indeed explosive progress, is continually blurring the very definition of thanatos?

"Before I Die: Medical Care and Personal Choices," which airs April 22 on PBS (check local listings), is a panel discussion - WNET New York, the parent station, calls it a "seminar" - about just this riddle. It is one of the "Fred Friendly Seminars," those open-ended, frank, and articulate discussions of important matters that have graced PBS with their intelligence since 1984. (Friendly is one of the truly great men in the history of television; along with Edward R. Murrow, he made TV news the noble thing it once was.) Flawed and occasionally maddening as the show is, it is eminently worth watching.

There are fourteen panelists on the show, including doctors, nurses, philosophers, a rabbi, and a minister. Arthur Miller of Harvard Law School is the host and master of ceremonies, and a more cloyingly self-satisfied one - except if it were Phil Donohue - would be hard to imagine. Miller, wielding his coffee mug like a scepter of office, struts before the seated panelists and asks them to "role-play" various scenarios about death, dying, family, and finances.

Now, in the first place, I've always thought that "role playing" was a goofy evasion of responsibility: If grown-ups can't talk, then they're not really grown-ups. And, in the second place, I'd bet the ranch that Brother Miller didn't have a damn thing in his coffee mug during the taping, and props that are just props tick me off.

But despite the creakiness of the setup, the hour produces discussion of real value. The three proposed scenarios, delicately calibrated, gradually increase the urgency - and difficulty - of making decisions about death in our current medical and ethical fog.

First case: A young mother has breast cancer. It's treated, but it comes back, and metastasizes to other parts of her body. Radical mastectomy, chemotherapy, everything is employed - but still the cancer is there, and spreading, and she is going to die. Does her physician attempt "experimental techniques" to prolong her life, or does he concentrate on measures to ease her pain in her last days? And what is her say in this? And what about the fact that her HMO may well offer her a fat sum (for her kids' education) to refuse treatment and die sooner rather than later?

Second case: An older guy, sixty-five or so, is still in the pink of health. But his physician convinces him to sign an "advance directive" - a statement that, if he is ever incapacitated beyond reasonable hope and on a life-support machine, the machine should be turned off. And then he has a catastrophic stroke, and is hooked up to the machine. (This is pretty close to the situation of my Notre Dame friend.) So how much does the "advance directive" really count - especially if his children are at odds about whether to let him die or not? And is the directive really legal if, maybe (but who can tell?), he doesn't want to die now?

Third case: A guy has advanced AIDS. He checks into a hospice, but still wants his doctor to promise him that, when the time comes, he will be provided the means to end his own life with something like dignity, something other than the howling chaos and loss of self which death from AIDS often is. And where, sufferer or caregiver, in the face of that immitigable enormity, are your abstract principles now?

I said that the scenarios were calibrated. But they do depict situations that occur every day. Remarkably, the doctors, nurses, ethicists, and ministers all agree that choosing death, even in extremis, is an unacceptable option, however alluring it may sometimes be. (I disagree, but this is not the right venue to argue my case.) And they also agree that the American health-care system is a galloping disaster, having turned "death" - whatever that means now - into a marketable commodity, as in "you got the bread, we'll keep you alive; you don't got the bread, you die." This, in fact, is fact.