What We Owe to Each Other

Ethics, bioethics, and medical ethics in particular, have never been about what humans can take from each other or the power that we hold over each others' lives. The answers to ethical questions fall more under the consideration of what is humane, and what we owe to each other. 

The content in chapter 3 of our textbook focuses on comas, and the ethical discussions that surround a patient in a coma. This topic, like so many others, is incredibly complicated. After a person suffers some trauma and they become comatose, at what point are they considered deceased? At what point do you pull the ventilator and/or feeding tube(s)? Or will they wake up and resume a semi-normal life 5, 10, 15 years from now? Do we owe a person a compassionate death by letting them go, or  is providing food and water to patients "the ordinary care that all human beings owe each other" (Pence 82)? Is a life worth living/prolonging if the remainder of their time will consist of physical and emotional pain for them and their family, a series of tubes, and massive medical bills? Is letting a person's body die considered merciful or harmful? What is it that we actually owe to each other, and who gets to make that decision?

While I have drawn my own conclusions, it would be sufficient to say that there will always be more questions and what-ifs when it comes to human life.

Whether or not it is feasible for a comatose person to return to a functional life often depends on the events that led up to them becoming comatose. If they experienced anoxia (lack of oxygen in the brain) for a prolonged period of time, or they have been declared "brain dead", then their state of unconsciousness is much more likely to be irreversible. Even when this is the case, there is still a great deal of variability between individual cases and a perfect standard may never exist. According to the authors of the textbook, the fact that anyone comes out of a long-term coma is crucial to any discussion about the topic, because it changes the course of a diagnosis from "certainty to probability" (Pence 75). This changes the emotional state of things, because instead of getting closure knowing that a patient has no chance of recovery, in most cases there is a very small chance that some degree of recovery is possible.

Without an "advance directive" or a living will that states what a person wants if/when they are in a critical physical condition, the decisions and pressure to answer all of these unknown questions often fall to family and physicians. There are issues with advance directives, as well. Many people are unable to accurately predict their own future preferences, as the SUPPORT study showed, and there is evidence that individuals designated as the decision-maker in critical situations often do not accurately predict the wishes of previously competent (but rendered incompetent by an accident/trauma/etc.) patients (Pence 83). 

So...what? It's complicated, I suppose. I don't have all the answers. If it were me, would I really want to be let go? I think so. I don't want to be a burden to my family, friends, or future spouse. But if I were in that situation, is that really what I would want? I don't know that there really is a way to know. If there was no chance of my brain returning to its normal functioning state, I would not want to be kept here. I don't want to suffer endlessly, or cause any of my loved ones to suffer either. I guess that's what it comes down to then, is that ultimately we owe each other a chance at life, but if that isn't possible, then we owe each other a chance at less suffering.

Textbook reference:
Pence, Gregory. Medical Ethics: Accounts of Ground-Breaking Cases. 9th ed., McGraw Hill, 2021.