Life of young American woman hanging by a thread

If you were Karen Ann’s father or mother, would you authorize disconnecting the machines?

Folha Espírita – December, 1975

Experts weigh in on the great dilemma

Clarifications by Chico Xavier for FE

The whole world is anxiously following the case of the young American woman, Karen Ann, whose life depends on machines.  Her family wants to disconnect the life support devices, but while awaiting a court decision, the appropriateness of this measure has generated a global debate.  FE conducted exclusive interviews on the subject with specialists, such as Dr. Alberto Lyra, and with medium Francisco Cândido Xavier.

Euthanasia

Dr. Alberto Lyra, a psychiatrist and author of several scientific books, honors us with his exclusive collaboration.

In Denville, near New York, at St. Clare’s Hospital, the young Karen Ann Quinlan, 21 years old, is being prevented from dying due to the effect of an artificial respirator and forced feeding to which she has been subjected.  She has been completely unconscious for six months, ever since she took several doses of gin mixed with psychotropic drugs.  She manages to breathe for brief moments without the machine, and her brain, according to the electroencephalogram, is still functioning.  However, this activity is minimal and precarious, as Karen does not move, see, or speak, which demonstrates total unconsciousness, thus making her life entirely vegetative.  For this reason, she is not in a position to decide whether or not she wants to continue living.

The mother and her adoptive father and guardian, Joseph Quinlan, chose to let the young woman die, which would be accomplished simply by suspending the artificial respirator.  This practice would be characterized as euthanasia.  “Euthanasia” (from the Greek: eu = good and thanatos = death) literally means good, gentle death.  The most common concept of euthanasia (though there are others) is that of death that is induced or hastened for merciful purposes, to eliminate pain or suffering considered incurable.

Now, Karen is in a state of unconsciousness due to a brain injury that is incurable and irreversible with the resources currently available in current Medicine.  If her brain were irreversibly and totally paralyzed and she remained alive through artificial means, her condition would technically be considered as death, with only artificial life support.  In fact, the patient would be less than a plant, because she is not living by her own means, she does not think, does not feel, does not have willpower, and does not move, unlike a plant, which at least has the superiority of living without outside help.

A mere thread of functioning brain activity is what differentiates Karen’s state from the one described above, and it is this tiny thread of active brain that technically classifies her as alive.  Practically speaking, however, the two conditions are equivalent.  Karen is, so to speak, nine-tenths dead and one-tenth alive, but alive only artificially.  Karen’s life is not being prolonged; rather, a state completely contrary to the laws of nature is being maintained.  Keeping her in this condition is driven more by ethical debates than by medical, logical, humanitarian, or practical reasons.

Socially, the human being is governed predominantly not by instincts, as Freud thought, but by values, as Max Scheller asserted.  For example, it is not sex that predominates, as many people claim, but rather a certain morality (a value) that regulates society and, for this very reason, prevents the free and natural expression of sex.  Similarly, Karen could be actively brought to the final state of death, or she may continue to be kept in this artificial situation, as a matter of ethics.

Ethics, however, varies with the times, with countries, and with philosophies of life.  Thus, there is Christian ethics, Hebrew ethics, Buddhist ethics, Islamic ethics, Kardecist ethics, positivist ethics, materialist ethics, Marxist ethics, and many others, which may be opposed, divergent, or irreconcilable with each other.  And each state, according to the philosophy of law that governs it, also has its own ethics.  There are also codes that derive from and depend on the state’s ethics.

In Karen’s case, there are two arguments for keeping her alive artificially:

• It is not permitted to take a patient’s life, for any reason. The patient should experience a natural death;
• Although considered incurable and in an irreversible state, it may happen that, at any moment, a scientist discovers a way to restore Karen to natural life, or, as the “impossible happens,” she might recover and become well suddenly, spontaneously and unpredictably.

The first argument is debatable:

• Karen is prevented from dying naturally;
• She is considered alive more for theoretical reasons than for logical reasons or common sense.  Is artificial life really life?
• Is it permissible to keep a person alive artificially?  A patient who is incurable and unconscious, sustained solely by artificial means, does not fully meet the criteria for life or death, but is instead regarded as an anomalous medical case;
• Aren’t those keeping Karen alive artificially assuming a terrible responsibility by violating the known laws of nature? Is it permissible to violate them?
• If we accept, in theory, that nature is the perceptible manifestation of God in the physical world, apprehended by our senses, aren’t Karen’s doctors violating God’s laws?
• And if, after this period of artificial, and thus unnatural, life, Karen returns to living autonomously, but with harmful consequences for her personality and/or with indescribable and unforeseeable suffering?  Won’t her doctors be responsible for this?

In Brazil, according to Article 48 of the Medical Ethics Code, the physician has “[…] the right to choose the treatment for their patient, always guided by the general principle of primum non nocere (first, do no harm).”

Well, if instead of letting the patient die naturally, the physician artificially prevents the patient from dying, wouldn’t they be sinning against primum non nocere principle, since the patient is unwell and could, although very remotely, risk becoming conscious but incapacitated and suffering?  Furthermore, the role of the physician is to assist and respect the laws of nature, and in the case above, they are acting unnaturally.  Is it in accordance with primum non nocere to artificially prolong the life of a patient considered incurable and in an irreversible state, causing emotional turmoil for her parents, which may harm their physical and emotional health?  To artificially keep a person alive and harm the health of two others who are intimately connected to her—and acting against their wishes—are those responsible for the harm caused to her parents?  While, at least apparently, no benefit is being provided to her?

They will resort to the second argument: although unexpectedly and unpredictably, Karen may recover. Well, this argument is specious, as it is based on an event so remote and, if not impossible, at least with a probability almost comparable to that of a miracle (an occurrence contrary to the known laws of nature). We believe that miracles exist, but we cannot guide our lives waiting for miracles; instead, we must base ourselves on probabilities and common sense. That is, at least, a pragmatic rule.

Article 56 of the same Medical Ethics Code states that the physician cannot, by action or advice, contribute to hastening the death of their patient.  In Karen’s case, the physician is not hastening death if they suspend artificial respiration.  She is a special case because she is not alive naturally, but artificially.  The physician is not causing death, but letting nature take its course within the limits of human understanding, acknowledging there are laws beyond our knowledge.

Thus, Karen will continue or not to live artificially as a matter of ethics, but, in this case, the choice is personal, individual, and not open to discussion, because it is a matter of value judgment imposed by state law.  The fact is that value judgment is controversial, and strictly speaking, no one can point out what is right or wrong.  Our argument is, as much as possible, attempting a judgment of reality, or trying to come close to it.

The case of Karen is relatively simple to resolve, as long as the laws of the State do not prevent it.  A medical board would be formed—because an individual physician cannot take it upon himself to make such a delicate and controversial decision—and if this medical board is guided by common sense, it would opt to suspend the artificial measures being used for Karen.  This is our personal opinion, which we do not wish to impose as the correct or best one, but simply to express it at the invitation of Folha Espírita, so that its readers may offer their criticisms or objections.

In Chico Xavier’s opinion, life-support devices should not be removed.

FE spoke with Chico Xavier in Uberaba, and here are his responses.

FE – Chico, how should euthanasia be analyzed?

Chico – In “The Gospel According to Spiritism,” Chapter V, item 28, this subject is addressed: a man is dying, in the grip of cruel suffering.  It is known that his condition is desperate.  Is it lawful to spare him a few moments of anguish by hastening his end?  The answer was given by the spirit known as Saint Louis, one of the spiritual guides of the Codifier of Spiritist Doctrine, and it is dated from 1800, in Paris: “Who would give you the right to prejudge God’s designs?  Can He not bring man to the edge of the abyss, only to pull him back, so that he might recover and nurture different ideas than he had before?  Even if a dying person has reached his last moments, no one can say with certainty that his final hour has come.  Has science never been mistaken in its predictions?”

As we can see, the opinion is clear and very logical, recommending the utmost respect for human life, even when we consider it to be in its last vestiges of resistance.  Thus, as Christian spiritists—not only from the Kardecist point of view, the Spiritist Doctrine, but also from the standpoint of conscience—we are beings who must respect one another until the final moment of the body and beyond.  Yes, because beyond the body, we have spiritual life.  Thus, we find euthanasia insufficient for promoting peace around us.

FE – In the specific case of Karen Ann, the young American who lives in a vegetative state, sustained only by special medical devices, what advice would you give to her parents?

Chico – First of all, it would not be appropriate for us to discuss a case that has legal implications in a country other than our own.  The laws of the United States of America prohibit the removal of devices capable of sustaining the life of a dying person.  Therefore, we should respect the laws of our North American brothers.  Secondly, we would calmly advise the parents to accept these provisions, because the American nation is setting a great example of respect for human life.

Personally, we believe that if our sister’s life is being prolonged and considered as non-existent on our physical plane, spiritually, she is in an anomalous condition that perfectly characterizes her state from the point of view of spiritual life, in the perispiritual body, until she fully returns to normal life.  Therefore, we believe that the dying person, even when approaching death, is in the situation in which they would inevitably be on the other side of life, if they passed away prematurely.

Thus, we consider the case to be quite normal from the point of view of the spirit, of the imperishable existence of our soul.  Our sister is heading towards another life and is preparing for it, just as all of us are in the condition of apparently healthy people.  Now, we must accept the laws of our North American friends because they are proving that we have nations that respect the life of the individual, and that we as individuals must trust in our laws.

FE – Chico, are there certain cases in which doctors could allow a patient to go without this artificial prolongation?

Chico – The matter falls under the competence and responsibility of medical professionals.  If we entrust ourselves or our loved one to them, and these professionals provide a particular opinion regarding us or those whom we have entrusted to their care, our attitude should be one of respect and acceptance of any instructions we receive from them, because they are entrusted with responsibility.

Would ending this artificial prolongation be considered euthanasia?  We are examining a case in which North American laws do not accommodate any idea of ending this same life, even in a very critical phase.  There is no doubt this is euthanasia.  But here, it is not a medical issue, it is a matter of the concept of euthanasia, to which we are positively opposed, because if it were to be approved, tomorrow we would also be encouraging wrongdoing in inheritance matters, issues of personal influence, and a lack of respect for human life.  It would be a clear disaster for our community life.  If we can dispose of the life of our fellow being, we are also heading toward criminality, albeit disguised as impunity within our own home.

The Legal Aspect

The case of the young American woman kept alive by an artificial respirator also deserves examination from a legal standpoint.  She is living a vegetative life, and her family is asking the judge to authorize disconnecting the devices that keep her in what is considered a precarious state of life.

For the law, the means used do not matter.  If life exists, even precariously, disconnecting the equipment constitutes homicide, even if it falls under the characteristics of euthanasia—hence, it is called “compassionate homicide.”  Even when there is a mere omission of aid, crime still exists, even if the omission is not committed by a professional (doctor), as long as there is a possibility of preserving life.  But who can say that a scientific discovery or an unexpected event will not entirely change the situation?

In Italy, Dr. Felice advocates keeping Karen Ann’s life-support devices in place, citing the case of his patient, Fabio Landolfi, who, at 10 years old, spent a year considered “clinically dead” but, once recovered, now lives a normal life.

In addition, it is necessary to consider the likely psychological consequences.  A woman recounts the case of her husband, who had cancer and metastases, underwent numerous surgeries, and was in a desperate state, “condemned to death.”  After hearing from her children, she agreed to disconnect his life support.   Now, she shares her story (O Globo, Rio, 11/2/1975): “For many long months, my doubts weighed as heavily as Julio’s absence.  And all of this drove me to drinking […]. But, no matter how much I try to convince myself, I still haven’t managed to accept Julio’s death.”