I’ve been completing a Health Care Directive. It will probably be this week’s least-favorite task. The form’s nine pages let me outline how I see medical decisions. And who I’d like to make those decisions for me if I can’t.
Picking my primary and secondary health care agents was the easy part, thanks to my being part of a close-knit family.
Making choices about organ donation, autopsy and what to do with my body after I’m dead wasn’t difficult.1 But it didn’t brighten my day.
Changing Times: Coffins, Cholera and Care for the Sick
Options of Yesteryear
My options would have been different in the 19th century. Different, but still unsettling.
The era’s health care tech and assorted epidemics encouraged skittishness when examining possibly-contagious corpses.
Waking up in a coffin was a real possibility.
My guess is that odds for waking up in a body bag are lower these days.
I’ve got mixed feelings about death.
Ideally, “…life is Christ, and death is gain.” But I’m not in Paul’s league. There’s also my particular judgment, and I’ve wandered off-topic.2
Where was I? Health care agents. Family. Autopsy. Death. Right.
Reapers and Disease
(From Robert Seymour, via Wikimedia Commons, used w/o permission.)
(Robert Seymour’s 1831 impression of a cholera epidemic.)
Folks who figured that old ways are good ways probably didn’t like the 19th century. Or the 20th. Or the 21st to date.
Scything and gathering grain gave way to mechanical reapers.
We lost an ancient tradition, but harvested more food in less time.
I figure that helped folks sidestep famines.
I’ve also read that famines declined because capitalism replaced feudalism. And that bigger bureaucracies led to better food distribution. Then there’s the British Agricultural Revolution and Green Revolution.3
There’s probably a grain of truth in those assertions. And that’s another topic. Topics.
As far as I know, nobody blamed the first cholera epidemic on Fulton’s steamboats or the Louisiana Purchase. Maybe because it didn’t spread beyond China and the Mediterranean.
All of which happened shortly before 1817.
Folks living in Bengal fingered Ola Bibi and Kali as being responsible.
British troops got blamed for the Bundelkhand outbreak.
Seems they slaughtered and ate cattle, which offended Hindu beliefs. On top of that, the incident took place in a grove sacred to Hurdoul La.
My view is that blaming a deity for death, disasters and disease isn’t unique to my culture. (February 23, 2019; September 17, 2018)
John Snow’s 1849 essay showed that tainted water carried cholera. The powers that be promptly ignored the idea. (July 1, 2018; July 21, 2017)
By 1896, we’d had the first through fifth cholera pandemics.
Doctors and scientists eventually learned that humorism and miasma theory didn’t match observable phenomena. That was happening during the late 19th century.
Well-established customs die hard, so bloodletting was an accepted medical practice until the early 20th century. That may help explain why American life expectancy didn’t get much above 70 until well into the 20th century.4
Surgical Successes in the Sixties
Fast-forward to the 1960s.
The ‘old ways are good ways’ set were having conniptions.
No cherished belief or institution seemed safe from scrutiny.
- European colonies became nations
- Eugenics laws were repealed
- Miscegenation was decriminalized
- Prefrontal lobotomies were becoming unfashionable
It was the end of civilization as we knew it. I’m not happy about every change, but on the whole I think we’re living in a (slightly) better world.
Brouhaha over drug-resistant microbes, genetics and other bioethical issues — I’ll get back to that.
A 1962 accident severed a boy’s arm. Folks got him and his arm to a hospital. Surgeons tried, successfully, to reattach his arm.
Christiaan Barnard’s 1967 heart transplant operation was successful. The patient survived 18 days.
Organ transplants are less lethal these days, which I think is a good thing.5
It’d be nice if everyone was perfectly healthy and weren’t missing any parts.
That’s not the way it is.
We’ve been using artificial limbs for millennia. (February 24, 2017)
Maybe that’s why I haven’t run across someone denouncing “Satanic” wooden legs.
Human-to-human organ transplants aren’t just new. They involve trickier bioethics.
Wanting to extend someone’s life by replacing a defective heart seems like a good idea. Problem is, whoever donates a heart won’t survive.
Here’s where it gets tricky.
Bioethics
Let’s say that one of my kids needs a new heart. I know a surgeon, hospital and suppliers with flexible ethics.6
They can locate and drygulch a suitable donor, extract marketable organs, and save my kid’s life.
And everyone lives happily ever after. Except whoever got broken down for parts.
That doesn’t mean organ transplants are basically wrong.
They’re okay if expected benefits outweigh the risks. Donating organs after death “…is a noble and meritorious act….” But killing someone to help another person is a bad idea. (Catechism of the Catholic Church, 2296)
Let’s look at another happily-hypothetical situation. What if one of my kids was in constant and unavoidable pain?
Not so hypothetical, now that I think of it. Surgery left my son with an unpleasant mix of numbness and pain.
Let’s up the ante, and say that he’s also crippled: not enjoying a “quality lifestyle,” as some said in my youth. Would administering a lethal dose of painkiller be compassionate?
Maybe, from some viewpoints. But euthanasia is not a good idea. (Catechism, 2277)
The same would apply to self-administered euthanasia. Whatever it’s called, that’s suicide: and a bad idea. (Catechism, 2280–2283)
On the other hand, I’m not obliged to continue ‘over-zealous’ medical treatment if I’m dying and ready to die. “Ordinary care” is another matter: and is an obligation. (Catechism, 2278–2279)
That can include painkillers, even if they’ll shorten life. The idea is that the goal is easing the patient’s pain: not killing the patient. “Palliative care is a special form of disinterested charity….” (Catechism, 2279)
I’m over-simplifying the situation.
A Task (Nearly) Done
Death and Signatures
My father died about 10 years ago. My father-in-law died last year.
I’ll die, too, sooner or later. That thought’s been inching its way toward the front of my mind, partly due to last year’s transient ischemic attack.
Contemplating my death isn’t among my favorite pastimes. Putting it mildly.
That’s made filling out my Health Care Directive a less-than-pleasant task.
But now it’s done. Apart from witness signatures and getting the thing notarized.
There’s more to say about life, health and death.7 But that’ll wait for another day.
Somewhat-related posts:
- “Sickness, Death, God, Love and Questions”
(February 23, 2019) - “Death, Funerals — and Life”
(September 30, 2018) - “Transient Ischemic Attack?”
(August 12, 2018) - “The Magi, Meds and Me”
(January 7, 2018) - “Different Sorts of ‘Dead’”
(November 11, 2016)
- MN Department of Health
- Life, death, health and transplants: my take
- “Face Transplant at Mayo” (February 24, 2017)
2 Life, death and safety coffins:
- “…death is gain.”
- Wikipedia
- Australian Museum
- United States Patent and Trademark Office, Patent Full-Text Databases
- Patent Database Search Results: CCL/27/31 in US Patent Collection
- My take
- “Death, Funerals — and Life” (September 30, 2018)
- “Different Sorts of ‘Dead’” (November 11, 2016)
- “Miscarriage, Stillbirth, and Hope” (October 9, 2016)
- Wikipedia
4 Health care and humorism, mostly:
- Wikipedia
5 New medical options and bioethics
- Wikipedia
- My take
- “Where Have All the People Gone?” (November 23, 2018)
- “Face Transplant at Mayo” (February 24, 2017)
- “Protection of Human Beings Trafficked for the Purpose of Organ Removal: Recommendations”
Assya Pascalev, Kristof Van Assche, Judit Sándor, Natalia Codreanu, Anwar Naqvi, Martin Gunnarson, Mihaela Frunza, Jordan Yankov; Transplant Direct; via PMC/NCBI (Published online January 4, 2016) - “Trafficking in Persons for the Purpose of Organ Removal”
Assessment Toolkit, UNDOC (United Nations Office on Drugs and Crime) (2015) - “The state of the international organ trade: a provisional picture based on integration of available information”
Yosuke Shimazono, Bulletin of the World Health Organization (World Health Organization) (December 2007)
- “John Paul II: Dying with Dignity”
Rev. J. Daniel Mindling, O.F.M. Cap.
(From www.usccb.org/issues-and-action/human-life-and-dignity/end-of-life/euthanasia/john-paul-ii-dying-with-dignity.cfm) - “Nutrition and Hydration: Moral and Pastoral Reflections”
A Statement of the NCCB Committee for Pro-Life Activities (April 1992) (From www.priestsforlife.org/magisterium/bishops/92-04nutritionandhydrationnccbprolifecommittee.htm)
Well done. Also worth noting is that “brain death” is not really death, as David S. Oderberg has pointed out in his book “Applied Ethics: A Non-Consequentialist Approach.” The idea of “brain death” seems to be promoted at least partly by those who are eager to harvest the organs of those who are not quite dead.
Thank you.
And thanks for bringing up “brain death.” Overly-eager harvesters may well have been promoting the broader definitions.
I hope there continues to be what St. John Paul II called “rational reflection” on the idea.
The last I heard, there’s an established trend toward defining unresponsiveness, brain death and the like in ways that don’t encourage concern over napping in a hospital’s waiting room. 😉 That is, I think, good news.