Euthanasia
S.Q.
Lapius was in his smoking jacket, rolling a lean
“Who
are or is the Smith family?” I asked.
“A
vexing case. They comprise a husband,
son and daughter-in-law.”
“And
what pray tell is the occasion. Is this
related to the bicentennial? Are they
related to Captain John Smith of Pocahontas fame?”
“No.
They are related to complete heart block.
I admitted Mrs. Smith the elder to the hospital this morning. Her pulse rate was 40 per minute, hardly
enough to keep the blood circulating.”
“Shouldn’t
pose a problem to an old master such as yourself. I should think a pacemaker would do the
trick.”
“So
it would, Harry, so it would, except there is a catch. It seems that the family doesn’t want a
pacemaker.”
“What
do they want? Are they confusing the
heart pacemaker with the boat? Perhaps
you should be more explicit when talking to them.”
“Even
when you try to be humorous, Harry, you fail to even be droll. It is simply that the old lady has been
failing. She is almost ninety years of
age, and they apparently think it would be kinder to all if she passed away
quietly.”
“Then
why didn’t they just allow her to pass away quietly? I mean why bring her to the hospital?”
“My
point exactly. But when I asked them,
they said that she was too difficult to handle at home.”
“And
they would like you to preside over the final moments. Lend your expertise to the dignity and
comfort of her ultimate demise.”
“Precisely. They wouldn’t sign permission for the
installation of a pacemaker.”
“Sort
of leaves you in the middle, Simon, doesn’t it?”
“Well,
it does raise problems and questions.
The patient is disoriented and incontinent. I must treat her medically. I can’t allow her to simply wither away. Yet, I suspect that without a pacemaker that
is just what will happen.”
“Your
hands are tied then?”
“Not
exactly.” The bell chimed. “That must be they,” Lapius waved me to the
door.
Mr.
Smith entered on a cane assisted by his son and daughter-in-law. We shook hands all around, and I immediately
forgot their first names, which was important because they were all named
Smith.
We
sat in a semicircle around Lapius who had refused to budge from his recliner,
but who, as a concession to hospitality, sat upright. The young Mr. Smith said, “We are
appreciative that you consented to see us Dr. Lapius.”
“It’s
no problem, sir, but I don’t see how I can help you.”
“Well,
you understand our position. My mother
is on her deathbed. Even before the
attack she was weak and failing. We feel
it would be just as well if no heroic measures were taken.”
“I
am not a hero, sir,” Lapius said modestly.
“I would have nothing to offer her but routine medical management. If that fails, I will have to introduce a
pacemaker. We will giver her 48 hours to
see how she responds to treatment, and then we will have to make a decision.”
Mrs.
Smith spoke tartly. “I am a nurse. I know about these things. What will a pacemaker do but prolong her
miserable life. It is useless, and we
will not sign permission.”
“Then,
madam,” Lapius said softly, “you should have kept her at home and let nature
take its course. I can’t be made a cat’s
paw for your intentions, however honorable and compassionate they might
be. Let us assume, for the sake of
argument, that I allow her to die, virtually unattended, medically. I would be liable for a malpractice
suit. Perhaps there is another member of
the family someplace who would object and say we had no right to make such an
important decision? Suppose there is
some lawyer representing a person who feels that one of you might make some
financial gain from the death of the patient.
Why should I become involved in this sort of shenanigan?”
“Well,”
Mrs. Smith said sharply, “We had hoped you would be considerate and
understanding and help us in this matter.
Surely you must understand that alive, she becomes an unbearable burden
for my father-in-law.”
“I
do understand that, Madam,” Lapius said sympathetically. “I am not unmindful of the consequences of
her recovery. But surely you can’t ask
me to participate actively in her death.
You are trying to make me a partner in what legally could be a
crime. For all I know, if a pacemaker
were inserted and enough blood were pumped to her brain by a properly beating
heart, all this confusion and disorientation you speak about might be
corrected, and she would become relatively self-sufficient.”
“Come
on, doc,” Mr. Smith junior intoned. “All
she wanted to live for was her granddaughter’s wedding. Well, that’s over so now she doesn’t care. Why don’t you help us out?”
Lapius
billowed some smoke into the room. “Why
don’t you help me out, and either take her home, or allow me to do my job to
the best of my ability?”
“We
are not taking her home,” the nurse said.
“She is too sick to be discharged, so you are stuck with it. We won’t sign permission for a pacemaker, so
your hands are tied.”
Lapius
sprang from the recliner. “In a moment
Harry will show you to the door, but not before I make one point. My hands are not tied. Here you all are talking about the right of a
person to live or die, unanimously voting that she should die. But the most important vote has not yet been
solicited. That of the patient. When the time comes, I will explain her
condition to her. I will ask her whether
she wants to have a pacemaker implanted.
If she does, she will sign the permission, and the deed will be done.”
“You
can’t do that. She’s senile.”
“If
that’s the case,” Lapius said stonily, “You had better rush to court and have
her declared legally incompetent, with yourself named as guardian. Otherwise, she is the only one who can make
the decision, providing she is conscious and apparently competent. Good day.” I showed them to the door. They were upset.
“Actually
Simon, you know damn well they have a point.” I said when I returned.
“Of
course they do,” Lapius conceded, “But in each case I must make private
decisions as to where to start, where to stop, how much is humane, and how much
is cruel. But whatever my decision, I
can never agree to conspire to something of this sort. I really don’t know the facts of this
case. Apparently everyone wants her
dead, but the truth of the matter may be that she wants to live. We’ll try to find that out during the next
day or so.”