A codicil to my living will

USA Today (Society for the Advancement of Education), Jan, 1996 by Richard M. Huber

Decision about the termination or prolongation of life should be made by the dying patient, not by physicians.

DEAR CHILDREN:

Of the Ten Commandments, only the fifth promises a reward -" Honor thy father and thy mother: that thy days may be long upon the land which the Lord thy God given thee." The honor that you shall do me is obedience to the following instructions.

Should I become terminally ill or permanently unconscious, I do not wish to be given any means of life support. Certainly, machines that can breath for me, pump my blood, and feed my faltering frame are a blessing when there s a reasonable expectation that I will be my "old self again." When the "new self" is a body comatose and a mind deadened with no expectation of recovery, though, the miracles of modern medicine become tragedies of unreasoning intent.

When my higher brain no longer is functioning, you should pronounce me dead. At any give time, 10-25,000 adults are abondoned to a persistent vegetative state. They join 4-10,000 children who also are wretched survivors in a comatose state. Their brain stems are working, but there is no conscious thought, no sensation. Imprisoned in a living death is not for me. Our higher brain is what makes us human. To exist without it is to be inhuman.

If an objective of life is to control the living of it for whatever ends we shall choose, why shouldn't an objective of dying be to control the manner of its arrival? What we must fear is not so much suffering, which can be softened by medication, but loss of control. Desperate medical personnel pounding on my chest, tubes inserted into orifices designed for other purpose, friends wondering whether maybe it wouldn't be "all for the best" to let me die - that's a death of aesthetic vulgarity and existential absurdity.

Death is a part of living. Death is not an event outside of life, but takes place within it. True, death does do something to life. It ends it. However, it does not end life outside of life, but within it. Thus, we should act to control death with the same intelligence with which we seek to control life.

I do not want physician to make decisions about my dying. Doctors should keep people alive. It is not really fair to ask a physician trained to prolong life to make the decision to end it. That is like asking a businessman to lose money. A doctor's job is to explain the medical options and consequences. Choosing to call life-saving measures "heroic" rather than "extreme" is a perfectly appropriate fantasy for physicians to treasure. Yet, they should not muddle their minds, trained in the natural sciences, with existential matters propery belonging to the humanities (what's best for me and for society) and the social sciences (what the cost in money is going to be.)

Physicians in attendance to the dying confront two alternative. Fees are accumulated as the life of the dying patient is prolonged and cease when his or her life end. Since few people prefer less money than more, a conflict of interest is inevitable.

Conflicts of interest, whether with politicians or physicians, are troublesome because the interest sacrificed too often is not that of the politicians, but the public; not the physicians, bu the patient, So, decisions about the termination or prolongation of life should not be made by doctors any more than time spent in office before the next election should be set by politicians.

Since your fidelity to my wishes may collide with the physicians' obedience to both professional principles and human cupidity, think of their role as automobile mechanics. The latter look under the hood, diagnose, and explain the options. They do not define priorities. My priority may be to patch up the faltering jalopy and take off for a European vacation. Or, I may junk it, purchase a new car, and stay home. That's my decision. Physicians look inside my body, diagnose, and explain the options. I do not want them to establish priorities about my living and dying. Do I want to live it up on a final fling to Paris or stay home and grow bald with chemotherpy? The science of medicine is not an instruction manual in the theology of living.

I am a Protestant and thereby emboldened to influence the will of God. Isn't the declaration, "It's God's will," a defeated admission that we were unable to change what happened? It was not God's will, Cintra, that your birth was delayed until two years after the wedding of your mother and me. It was our will exercised through birth control. We wanted to get to know each other before the house filled with bawling, but gladsome, distraction. Planned parenthood helped us measure the timing of Richard's and then Casilda's arrival. Planned death will attempt to influence God's will so that it corresponds more precisely to out own. Should He choose to have His own way, He can not but approve my pluck. After all, God helps those who help themselves.

Philosophy probably began in the contemplation of death. Certainly it was so for the ancient Egyptains, who built pyramids to defeat the Grim Reaper's inevitability. You mean death is the end? No way! Still, there is not much we can do about the after-life, or no-life, except to multiply virtuous credits against sinful debris. At the Pearly Gates, St. Peter will calculate our balance sheets in a ritual of retributive justice.