The call came just before 1 am. “Mr. Trippie, your father stopped breathing. He was without oxygen for 7 minutes. We were able to revive his heart, but he could not breathe on his own —we have him on a ventilator —get here as soon as possible.” Ethics seems like an abstract philosophical category until one gets that call.
Ethics is concerned with morality —what acts are right and what acts are wrong. Most days, we can make these decisions without much thought. Generally, most people do not need to think long to decide whether to rob the bank or blow up a building. We all have a belief system that places boundaries on our actions. But in today’s complex world of artificial intelligence, medical technology, and competing value systems, an act’s “rightness” or “wrongness” is not always clear.
For instance, when the doctors asked, “What do you want us to do?” we were confronted with several choices —none of which we wanted to make. Dad had suffered a stroke 70 days prior, and his mental and physical capacities were severely damaged. But was it right to keep him alive on a machine and hope for a miraculous recovery? This option seemed consistent with our values of faith, hope, and love. Yet, removing the ventilator also seemed consistent with our values of mercy and beneficence. The challenge in situations like this is not that we do not know our values. Instead, the challenge is that our values conflict, and our desired outcome is unlikely.
In fog this thick, one must find flares of thought to guide one’s decision-making. First, one must gather all the facts. In my father’s case, oxygenation ceased for over 7 minutes. While recovery is not unheard of, he already suffered irreversible damage from his stroke. The facts were that his chances of recovery were extremely low.
Second, one has to consider the nature of the act under consideration. Is removing a ventilator the same as euthanasia or physician-assisted suicide? Euthanasia means “good death,” and in our current cultural climate, many see this as an act of compassion. But euthanasia and physician-assisted suicide intentionally and actively end a human life. The stated goal of euthanasia is to end life.
However, removing a ventilator is different under the following conditions: (1) The loved one is late in the dying process. (2) Conditions are such that treatment is futile. (3) Death is not directly intended, and the actions taken are not the direct cause of death (for my father, the cause of death was a stroke, which was a natural cause, not the removal of a device). (4) The person previously made an autonomous decision not to be kept alive artificially and communicate these wishes to a loved one. Thus, when all things are considered, it seems that euthanasia or physician-assisted suicide is an act of intentional killing. Whereas the removal of a ventilator, under certain conditions, is akin to “letting die.” “Letting die” simply allows nature to take its natural course.
Third, one must consider the virtues formed in the act. For instance, what happens to the inner life of a doctor who intentionally and actively ends a life? Physicians commit themselves to the Hippocratic Oath, which pledges to “do no harm.” What happens to a doctor’s conscience when they violate their oath? Moreover, what about the family that will not confront reality? Courage and compassion are often formed in these moments of crisis.
Fourth, when values collide, we must consider all options. In the fog of moral decision-making, we are prone to tunnel vision. But we often have more options than we first realize. When faced with critical decisions, it is not a bad idea to return to the old-school yellow pad and write out all the possible options. If nothing else, this process will help one to ask the right questions even if the outcomes do not change.
Finally, we must consider the outcome. While we know it is impossible to predict outcomes with a hundred percent certainty, we can discern what is highly likely. All our decisions have consequences, and we can reasonably ascertain how those consequences will align with our most deeply held beliefs. In our case, our family’s highest belief is that life does not end in earthly death.
Christian philosopher Gilbert Meilaender said, “Life is a great good, but not the greatest good. For the greatest good is fidelity to God”. Our faith teaches that life is to be cherished and preserved, but there comes a point when one must accept that life in this realm is not ultimate. It’s been nine years since we made the decision, and while suffering and heartache are part of the human condition, our comfort is still forthcoming in the final reunion.
Gilbert Meilander, “Euthanasia and Christian Vision,” Thought: Fordham University Quarterly 57, no. 4 (1982):457.