Death, Where Is Thy Sting?

I have long had an interest in ethical issues in medicine. One such issue that has continued to generate controversy is the answer to the question, "When does death occur?"

There have been high profile cases, especially in the United States - think Terri Schiavo - that made it to high level legal encounters and other cases that no one outside the family knew about. There have cases where intense religious arguments were involved and others where only secular arguments were made. There have been cases centering on legal definitions and others dealing only with medical criteria.

Regardless of the specifics of a particular case, one thing became clear to me. The medical technology to continue the functioning of the body far outpaced our thinking about the question of when did death take place.

As a pastor, I have stood with a family next to a bed and watched the last breaths of their loved one. There were always certain signs, but no one death precisely imitated any of the others.

In today's Toronto Star is a story about a young Canadian girl that has re-invigorated the debate over life and death issues in that country. A 2 year old girl was removed from a ventilator, after the family was told that she could not live without a respirator, in order to remove her heart which was to be transplanted into another child. After the respirator was removed, however, the little girl continued to breathe. Quoting from Stuart Laidlaw's story,
"This little girl just wasn't ready to die," says Moira McQueen, director of the Canadian Catholic Bioethics Institute. McQueen worries about a blurring of the line between dying and dead, saying we sometimes treat people as already dead once they are deemed terminal – a notion Kaylee challenged with her survival."

The issues are many and varied. Should death be defined: by the cessation of breathing, by the heart stopping, or by the end of brain activity? Or should some other criterion be used? If you pick one specific standard, what do you do when there is a machine that can continue that function when the body can't or won't? Should any machines be used to help prolong life, however it is defined? Should a family refuse the use of any machines or any procedure that might prolong the life of their loved one?

How do you decide? And, what should you decide?