Wishes Aren’t Evidence
Americans devoted much debate and discussion recently to President Bush’s historic decision to permit limited federal funding of research on embryonic stem cells, formed at the beginning of life. With much less prominence, the same day the California Supreme Court issued an important ruling on the end of life. The ruling prohibits families from removing nutrition tubes from severely brain-damaged but conscious members without clear, convincing evidence that the patients would want that. Such evidence isn’t required for those in irreversible comas. The patient in the case before the Supreme Court, Robert Wendland, had already died of other causes, but the judicial precedent will live on in California.
We’re uncomfortable with government dictating to families what they can and can’t do in such excruciatingly personal, painful times. One family’s cherished life, even vacant of mental response, is another’s living hell in suspended animation. Doctors well know that emotions and guilt surrounding the impending death of one member can sunder the most loving family.
However, this unanimous court decision seems a reasonable, cautious half-step as our inattentive society drifts through the slow, arduous process of consensus-building while medical advances race ahead. As Justice Kathryn Mickle Werdegar carefully wrote: “The decision to treat is reversible. The decision to withdraw treatment is not.”
Requiring such patient directives can also provide valuable patient protection in an era of cost controls, when medical decisions could easily be swayed by financial concerns. The ruling disappoints doctors, who predict unnecessary, futile care, and right-to-die advocates, who note that it ignored Wendland’s presumably devoted wife’s insights and wishes. But wishes are for falling stars. In real life and death, courts require evidence. And they must protect the unprotected. Wendland, like most Americans, left himself unprotected--no signed, dated evidence, not even a videotape stating his preferred or disdained treatments. Who anticipates a car crash?
There is an alternative. Anyone can formally designate a friend or relative to make medical decisions in the event of incapacitation. A person can share his or her values with the designee and family, a dispute-prevention step now recommended for would-be organ donors. During routine medical visits, family doctors could suggest such steps.
All this would, of course, require personal initiative, something Americans don’t hesitate to display when debating distant issues like stem cells and the start of life. But when it comes closer to the end of lives that are close to us, evidence suggests we’d really rather skip the subject altogether. Unfortunately, that leaves it to the courts, and they are right to be so cautious.
