End of Life?

The very sad case of Eluana Englaro was in the news today as her father finally won his court appeal to allow his daughter to die. Eluana was involved in a car accident in 1992 and has been in a coma ever since. She is currently fed via a feeding tube which her father will now order discontinued. The Catholic Church is understandably upset, calling this “assassination” and “consensual homicide”. I think this is overstating the case by a large margin, but I do understand their concern.

Every doctor hates patients like this. Young people (Eluana was a teenager at the time) in persistent vegetative states are a nightmare. Unlike the elderly following a stroke, young patients have strong hearts and constitutions and tend to survive many years. A neurologist friend of mine once told me that a good rule of thumb was that a patient’s chances of coming out of a coma halved for every day they were in it (unless, of course, it is a medically-induced one using drugs). At 16 years, Eluana’s chances of coming out of her coma are orders of magnitude worse than your chance of winning powerball. Unfortunately, we do not know enough about coma states to say “she will never wake up”.

Therein lies the problem. The Church would very much like us to be definite about this. They say that, if there is any chance of her waking up, then non-intervention is tantamount to murder. But at what point does it become futile? I recall a recent case of a man coming out of a coma after 24 years but this is extraordinarily rare. And is his case different from Eluana’s? Are their certain factors that make late awakening more or less likely? We simply don’t know because the event is too rare.

And I think it is the very rarity of this kind of event that gives us a clue here. While the Catholic Church is arguing that survival is possible and that God can work miracles, it is just as easy to argue that this poor girl died in 1992 and only the intervention of man has kept her alive. Both scenarios are theologically accurate but only the latter truly deals with the suffering of her unfortunate father  

It is clear from the father’s persistence in the face of a great deal of opposition, that his suffering is intense and that he genuinely wishes his daughter to be at peace. I find it very hard to see a man bent on killing his daughter because she is a nuisance or a burden. Accordingly, I don’t see this case as a strengthening of the case for euthanasia. The man has waited patiently for 16 years (well 6, because he started legal action 10 years ago). It does not seem like a hasty decision to me. Let her be at rest.

Note that this case is nothing like that of Terri Schiavo. Terri was severely brain damaged but awake and reacting to things around her, albeit not consistently enough for doctors to consider her truly conscious. In her case there was also clear contention between family members (her husband and her parents) as to her wishes in this situation. Given her transient waking states and lack of agreement about her wishes, I believe the final judgement allowing her to die was quite dubious – but at least it was properly tested legally.

End of life issues are horribly difficult. Because of this, I think it is best that each case should be tested in court. I am not in favour of legalising euthanasia in any form. These issues are much too complex to allow politicians to determine the outcome.

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