Tuesday, February 22, 2005

Veggie Tales

This article over at Alas, along with this week's episode of ER, reminded me of something I had been meaning to write a post about. That is the issue of keeping those that lay persons call "brain dead"*, or in a persistent vegatative state, alive with ventilators and feeding tubes. A lot of the discussion seems to revolve around what the victim would want. "I don't want to be alive as a vegetable," we often hear people state when considering such a fate.

But you know what? I don't care. If my cerebral cortex and the other parts of my brain that contain everything that is "me" are dead, if I am unaware and unfeeling without any reasonable hope of recovery, I am dead. It's no skin off my back whether my body is kept alive or not. I'm not there anymore anyway. Whether my body continues to live, atrophying, ridden with bed sores, or is rotting away in the ground, neither option is particularly pleasing, but neither one is really any different than the other. Either way, I am dead.

I mean, in the afore-linked Terri Schiavo case, she has been in a persistent vegatative state for 15 years. There is no brain activity. The chances of her ever recovering or even opening her eyes or speaking again are about as remote as my chances of ever playing in the NFL. Sure, either one could happen, but realistically, it doesn't make much sense to force people to base choices on such remote possibilities. Otherwise, parents should be thrilled when their sons or daughters announce that they want to be professional atheletes or movie or rock stars and therefore don't need to go to college.

If I'm in such a state, I'm dead. If my family wants to keep me alive so they can hope, whatever. Good for them. If they want to pull the plug so they can move on with their lives -- as I feel rather certain they would quickly decide to do -- that's fine too. The only reason I wouldn't want to be kept alive is because it's a stupid use of medical resources and money, but, frankly, after I'm dead, what the living decide to do with their resources and money isn't my concern anymore. It's no skin off my back for my empty shell to sit in a room for thirty years and if that's what my family wants. They are doing it for themselves, not for me, so I wouldn't be using up those resources. They would.

Now, I'm not talking about cases where this a reasonable statistical chance that I might recover, as opposed to a snowball's chance in hell. And I'm not talking about when I'm still alive and aware but simply cannot stay alive without a ventilator and feeding tube. I really don't know what I would want then, frankly, because it's just too hard to really imagine myself in that situation and really know. And I'm not talking about something like Alzheimer's, where whatever part of me still exists is very likely suffering.

But Terri Schiavo can't suffer anymore. Only her family can. In these kinds of case, the focus seems to be on the victim and his or her theoretical wish to die versus her right to continue to live even if she never recovers. But I don't think it's about the victim anymore once it becomes clear that the person is never going to wake up. Terri Schiavo is dead. As noted at Alas, she has been dead for fifteen years. The question, in my mind, shouldn't be about what she would have wanted or whether she has a right, as a living thing, to continue living. It should be about doing the least suffering and harm to those still living, particularly his or her family.

And, as such, though taking Terri off the feeding tube may cause some suffering to the right-to-lifers who want her to continue living, I think it pales in comparison to the suffering caused to the family who will have to keep on living in a shadowy world of grey where Terri is gone but they cannot yet finally let go and grieve. I think the harm to society, if any, of letting families decide it is time to say goodbye is just not sufficiently grievous to warrant forcing them to live in that shadowy world for the convenience of the rest of us.

As for me, whether I have rights in this regard or not, I don't care. Once I'm gone, baby, I'm gone, and even if an angry mob cuts off my head and kicks it down the street (as I hope will happen, but only after my death from natural causes at the end of years of my totalitarian rule) or a necrophiliac has his way with my remains, it makes little difference to me. A person must exist to be humiliated, and after I die, I no longer exist. The living can desecrate my memory, they can humiliate my family and those who care for me, but they can't do anything to me. There won't be any "me" to humiliate.

* The term "brain dead" is nonsensical in the medical sense. Once a person's brain is dead, the person is dead. Cessation of all brain functions is pretty much the medical criteria for determining death. The lay term "brain dead" is actually referring to the death or permanent disabling not of the brain as a whole, but of the higher functions of the brain. A "brain dead" person's brain is actually not entirely dead; even if the person cannot breathe on his or her own, some parts of the brain's regulatory centers must still be alive and functioning in order for the person to continue to live. The body cannot continue to live if the entire brain is dead and all its functions have ceased, for it cannot sustain life without the brain to regulate it.


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