Because that’s a decision that can be changed if new information comes to light - either new medical information or new information about the patient’s wishes.
The opposite approach - mercifully killing the person - has the downside that if new information comes along showing he WANTED to be kept alive, you cannot undo the action.
You can’t “undo” keeping people alive either, though. Should you keep a patient alive only to discover they hated every minute of it, you can’t just say “Right, we’ll go back and kill you, then” anymore than you can bring them back from the dead.
Okay, this is a legitimate point, but very few people have ever come out of this kind of condition in any kind of shape to tell us what they were experiencing. Most of them just die in this state. Wouldn’t a rational approach be for us as a society to discuss this and take a poll on whether most of us would want to be kept alive if we were non-responsive with very poor chances of recovery and then base our policy on what most people want? We could make allowances, of course, if people made up legal documents saying that they wanted all measures taken to keep them alive. Modern medicine has given us this predicament fairly recently, because it takes so much more than just food and water to keep people alive when they aren’t consciously cooperating. I think most of us would prefer not to be kept in this state, but most of us won’t go get a living will made up. We’ll procrastinate and put it off, just because it seems very unlikely that it will happen to us, and besides, we don’t want to think about it. But once it has happened, all your power to make choices is gone.
We really do have to have a national dialog and come up with some better policies, because medicine is improving to such a degree that they can keep you alive without your being conscious or physically able to consent or object for longer and longer periods.
I have answered this already. There are two broad possibilities: one that he wants to live and would most likely experience being put to death as murder, and the other that he wants to die and would most likely experience being kept alive as torture. In the context of a health care setting, there are many things we can do to minimize the likelihood that being alive will be experienced as torture. If you decide not to keep him alive, it’s a lot more difficult to imagine a death (even by needle) scenario that’s not experienced as murder, unless as I noted it’s going to take place in secret, with him completely unaware that it’s being planned and executed “for” him. In the absence of information that those are his wishes, I would not do it (unless he cut me off in traffic). So what exactly makes you think that the default choice in this case should be to actively kill him?
Not just that, but you wouldn’t have a moment away from other people either. You’d be surrounded by nurses 24/7, you would never have a moment’s rest from either yourself or others (if you can detect these others). It would be a strange combination of total isolation and total companionship.
While I would consider being locked in or in a PVS to be torture, I have to side with the people who say that the default action, in the absence of a living will, should be life support. Torture is bad, but giving death (however merciful we may think it is) to someone who might not want it is worse. I think of this and organ donation on a sort of parallel: in my opinion, people who don’t donate their healthy organs to others are selfish assholes. However, if any law were passed that said “organ donation is now default,” I’d consider that to be immoral and wrong. We should always side on the more conservative option for these things, no matter how much it may be painful to see someone in a PVS. All the more reason to get one’s living will in order.
Correct. But some decision must be made. I find this very analogous to imposing the death penalty. It would be horrible to wrongly imprison an innocent man, but at least, if the mistake is discovered, we can free him. We can’t say to him, “Right, we’ll go back and un-imprison you.” Still, it’s better to imprison him than kill him.
Here is my solution to this problem.
We make the default state to be “pull the plug”
If you don’t want the plug pulled (feeding tube removed, whatever), you carry a health insurance rider to keep you alive indefinately in a vegatative state.
That takes care of two of the big issues - not knowing if someone wants to be kept alive and who pays for it.
Normal insurance would cover some sort of time period (not a medical expert, not going to claim I know a good period).
I had the death penalty in mind when replying to your post, too; this is one of the reasons i’m against it. I’m uncertain on this issue, but I think i’d agree with you that keeping people alive should be the default, bearing in mind that either way things can go pretty spectacularly wrong.
Why not just ask everyone what they want when they get insurance, and state that there will be an added fee for people who choose life support? Or ask people to list their preference on their state ID/driver’s license, like we do with organ donation? I guess I am just uncomfortable with making plug-pulling the default, even though I would ask for it myself. Because euthanizing someone who was dead set against it would be a tragedy, even if most of us would choose it.
Sure, but often all other information isn’t absent.
Indeed. But the fact that you imagine that scenario suggests you have a very very different idea of how the brain works than modern medicine does. And, to be fair, I think most people do. Both the people talking about active suffering AND those thinking about having deep thoughts are probably off the mark. We can’t know for sure in a metaphysical sense, of course, but generally experiencing suffering in a human sense is something that takes a pretty decently intact cognitive function, to the point where communication is probably to some degree possible. So I guess talking about these people suffering is overplaying things. Certainly that body is in a lot of pain. But suffering is hard to nail down.
Interestingly, people that are actually “locked in” (that is, we KNOW they are still almost 100% conscious, but they’ve simply lost the ability to communicate by physical means, as far as we know) seem to tend to basically lose their minds after a time and become, as best I can describe: slow and shallow (in the sense of not having much going on in their heads and complex ideas simply not registering anymore). It’s sort of depressing in a way, because we have started to discover all these new tricks to reach out to these people (most of which involving allowing them to communicate just by thinking since they are physically unable to move anything volitionally, but as far as we know their minds are fine). We expected to have gloriously saved these people: made contact and brought them back into communication with us.
And yet, without the ability to reach out into the world, the mind seems to eventually cut its losses and retreat back into primeval, almost animal awareness, without the “person” re-emerging as if they had just been locked away for awhile. This could be temporary of course: most of the people I’m talking about have only just within the last year or so had this technique used. But it’s certainly not promising. So the idea that a locked in person would just be a normal person with normal thoughts going “hey please kill me” or “hey, don’t kill me” and such doesn’t seem to hold up very well for either side of the debate.
I agree. I’m not for any official policy other than “continue good medical care” being the standard unless the patient or their duly instated guardian says otherwise. That’s just how medicine works and needs to work, though of course financial conerns eventually do play a part.
But if one of those guardians asks me, I’m going to tell them straight out that keeping someone alive endlessly with no even slightly realistic hope of a positive recovery is just bad, and often based on a lot of cruelly false hopes. Modern medicine can work wonders, but there’s sustaining the body, and then there’s bringing the person back, and our ability to do the former is far far outstripping the progress we are making in the latter. At a certain point, physically sustaining the body is not really medical care anymore: it’s just doing it because we can.
What is someone’s ‘default position’ when they are dead? To be left dead? Or to forcably bring their organs back to functionality and then keep them alive artificially?
That’s pretty much what I’m proposing. Either an opt in or an opt out on your insurance coverage, with you paying an additional amount to cover maintenance while in a PVS.