Eluana Englaro Dies
Eluana Englaro is dead. Who? – most of us will be asking. Eluana was involved in a serious car accident in 1992. She has been in a persistent vegetative state ever since. Her father has been fighting legal battles since 1998 to get the doctors to stop feeding her. He won the right to let her die in November but political machinations have prevented her from being allowed to die until today.
The newspapers are wrong. They say Eluana died today, a 38-year-old woman. But she actually died in 1992 – at the age of 21. Medical science kept her heart and lungs going for another 17 years. They fed her with nutritious goop via a tube into her stomach. They turned her to prevent bed sores. They gave her antibiotics each time she caught pneumonia or a urine infection. Doctors checked her temperature chart, nodded and walked on. Physiotherapists moved her limbs to prevent contractures. Nutritionists checked her weight and changed to goop from time to time.
That is a lot of work for someone who is dead. And a lot of heart-ache for a father who knows his daughter is long gone. I have a 21-year-old daughter. I cannot imagine what he must have gone through, all these years. I am glad he can put his daughter to rest and grieve for her properly.
I have blogged about the end-of-life issues in this story in an academic sense here. But today I wonder if I would have had the courage of Eluana’s father to seek an end to his daughter’s living death, or whether I would be one of those who cling to hope even after all hope has gone and only the cold expertise of technology remains.
I pray that I will never have to find out.
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Feb 10 09 12:04 pm
I hope that I would be as strong as that poor man, but I also hope that my family will fight to do the same for me should the need arise.
Feb 10 09 2:50 pm
I agree with Pique Oil.And have you noticed how the newspapers always show a wonderful glowing pre accident photo of the person in question?As if they still look like that after many years of hospital care.The reality is so different.
Beam me up Scotty when my time comes.
Feb 10 09 6:36 pm
I’m Italian, so i followed this story. I’m also an atheist, so I won’t be accused of being a religious fundamentalist.
Maws said: “have you noticed how the newspapers always show a wonderful glowing pre accident photo of the person in question?As if they still look like that after many years of hospital care.The reality is so different.”
Actually, you have it in reverse. Yes, the total and complete lack of present day Eluana pictures is the biggest elephant in the room in this issue. And it’s Eluana’s father, the “mercy killer” who insists in only showing to the press picture of a smiling, young Eluana. Meanwhile journalists can’t get near Eluana without violating privacy laws, so the father has the monoply over Eluana’s image. My take is that he didn’t want the public to see the present day Eluana – precisely because she did NOT look as devastated as he wants us to believe. All the doctors who examined her declared that she was a very healthy woman, with no disease other than the lack of reactions due to brain damage.
Let me stress the fact that people in a coma, and even more so people in a vegetative state, are sometimes able to perceive the outside world. I know this is an unorthodox statement; if you doubt it, just ask the people who have been directly involved. My own grandmother woke up from a coma, and she told me about hearing people speaking to her during that time. In Italy, Salvatore Crisafulli is famous for having awakened from a vegetative state that lasted many years. He says that during all those years, he saw and heard everything that happened around him, but could not give signs of consciousness. He says he was in despair every time he heard people refering to him as “dead”, because he felt alive.
This has two implications:
1- If these people can hear and see, then the life of such people may have value even if they lost any ability to recover. Who said that you can’t enjoy life when you can still see and hear things? And even in those case in which they can’t see and hear, they still have brain activity, so they can presumably harbor thoughts and dreams. They are not “dead”.
2- If these people can hear and see, then they might also feel pain. This is important because both Terry Schiavo and Eluana Englaro have been starved to death, which is an extremely cruel and brutal method of killing. This is far from “mercy”.
Now, Eluana’s father said that her daughter would have wanted to die. Did she sign a document stating this? No. We only have the father’s word for this. Yet an Italian court ruled in favor of killing Eluana – a decision based on informal statements, reported by a single witness. Even if Eluana’s father is honest, this is an ugly precedent. A person may have countless reason to be dishonest and let a relative die – from inheritance to personal dislikes. And informal statements could have been superficial talk or jokes, and shouldn’t be taken into account in this context.
Some of you will say that if you ever happen to be in a coma, you would want to be killed immediately. I, for one, would want to live at all costs. However, with a precedent like that, I could get killed under the guise of “mercy”. You don’t have to be a jurist to understand that killing a person who desires to live is murder.
Feb 10 09 7:05 pm
In reading your (End of Life) opinions about the value of human life when not lived to the world’s view of worth, maybe it’s time to begin thinking outside the worldly box as to the consequences of our ‘CHOICES’ in this short life on earth.
I’m wondering if you realize you stated: \I pray that I will never have to find out\ regarding the decision to \cling to hope\ for a miracle (which do happen), or cutting a life short by withdrawing life support. I can only presume that you pray to the same God that I do, and in that vein I offer the following thoughts;
Suffering is not an option, and not to be rejected, for the real ‘Hope’ of spending all eternity in perfect union with God (the Most Holy Trinity) for those who acknowledge and obey Him. \Thou shall not kill.\ \Those who do not pick up their cross and follow Me are unworthy of the Kingdom of Heaven.\
Life is a thing of value in itself; it’s value doesn’t depend on the extent that it brings pleasure and well-being.
This means that suffering and pain do not stop life being valuable, and are not a reason for ending life.
True compassion leads to sharing another’s pain; it does not kill the person whose suffering we cannot bear.
Maybe everyone should find a peaceful and quiet place of their choosing, gaze upon the Blood Soaked Cross of Golgotha…and \Behold the Man.\
There’s your answer.
Feb 10 09 11:08 pm
Caballaria: Thank you for your comments. As far as I am aware, Eluana had had no registrable higher brain activity for years. This is why I think her father’s decision is correct and that she has indeed been dead for many years. This is what I have based my comments on.
Salvatore Crisafulli is thought not to have been in a persistent vegetative state but rather in a “locked in” state where processing in the brain is normal but thought cannot produce motor action. Typically these people respond to simple commands such as “open your eyes” and have obvious brain activity on EEG. Terry Schiavo is also different, in that she had moments of near lucidity and had some higher brain activity on hearing speech.
Understand, I do not approve of euthanasia in any way both as a Christian and as a doctor. But I also do not approve of our attempts to behave in a “godlike” by using technology to maintain organ activity when the patient is clearly dead (has ceased recognisable brain function).
Feb 10 09 11:30 pm
Phil: Thanks for your input. I think you are talking about the wider issues of suffering and pain in the context of Christianity. As Paul himself points out, suffering really only takes on meaning in the context of an eternity with the Father. Unfortunately, this has little meaning for my unbelieving patients who see suffering as imposition, rather than a brief travail.
Having said that, I have worked for many years in hospice clinic, and with dying patients. Terminal illness and suffering, in my opinion, has never been a reason to reject life, but a reason for doctors to make more effort to alleviate their patient’s tribulation. I think that euthanasia is not only an ungodly solution to pain and suffering, but a medically inappropriate one as well.
When I have time, I will certainly explore the subject of euthanasia in greater detail in a later post.
Feb 11 09 3:19 am
Thank you for your reply, MacDoctor.
I have no medical expertise, but I heard on Italian television medical experts state that Eluana’s brain did send electric signals and that she was even able to swallow, even though she was being fed through a tube. What are your sources in stating that she had no higher brain activity?
I also heard that the definition of vegetative state is simply the lack of reaction rather than the lack of brain activity. Thus people in a \locked in\ state as the one you describe might fall under such a definition of vegetative state. I think this was the definition used for the case of Eluana.
Feb 11 09 7:36 am
I have to argue,what is the point of a life like this?.Without man’s intervention,Eluana would have died a long time ago.
Feb 11 09 11:43 am
Caballaria: Unfortunately, the term Persistent Vegetative State (PVS) covers all conditions in which the patient cannot communicate or respond after a brain injury. I say, unfortunately, because this means that PVS covers a large range of conditions from complete brain death (Eluana) to Minimal brain function (Terry Schiavo) through to normal brain function (“Locked in”). This makes debate on this condition very difficult.
My information is that Eluana had no higher brain activity on EEG (I don’t know about MRI). I received this information from a neurologist friend who has been taking an interest in the case, but I don’t know his information source.
I must point out that all my comments on Eluana’s death are made on the basis of this information being true (that she was actually brain dead). In this situation, and this situation only, I support withdrawal of nutrients and liquids. If my information is wrong, then my opinion on this matter would change.
I do not support euthanasia as a method of “ending suffering”. The temptation to play god in this regard is too great. I am firstly a Christian and then a Doctor. Both require me to cherish life and alleviate suffering. They do not require me to decide whether a life is worth living or not. They do not demand of me that I decide when and how a life should end. Both the value of a life and its end are things best left to God.
Feb 11 09 11:48 pm
I think your information is wrong.
Berlusconi dramatically stated that Eluana had detectable brain activity.
Had such statement been false or easily refutable, Italian opposition politicians and journalists would have called the premier on that, since they never miss a chance to criticize him. But I didn’t hear anybody claim that the he was wrong about that.
Nor I heard anybody object every time in debates, opposers of euthanasia made the claim that “Eluana is not braindead”.
Besides, I know for sure that in the first years after the car crash she was being fed normally, without a tube. She was able to swallow. How would she have got from that to braindead?
Feb 12 09 12:19 am
Caballaria:
It is perfectly possible my information is wrong.
However, I should point out that the ability to swallow is a brain stem (automatic) function and does not denote higher brain function (consciousness/awareness). Similarly, lay people often become confused if the brain stem is working well (and the body reacts to pain, blinks and swallows), but the frontal lobes are silent. It is possible to have a great deal of automatic lower brain activity while the frontal cortex, where we do all our thinking, is obliterated. This person would still be considered brain dead for end-of-life discussions, but would still have appreciable brain activity.
An EEG or, even better, an MRI with activity stimulation are currently the only ways to determine if the frontal lobes are active. You cannot tell simply by looking at a person.
This is a highly emotive issue, particularly in a strongly Catholic country like Italy. I would be surprised if any rational scientific debate has taken place in parliament or on the web.
Feb 12 09 7:44 am
Actually, Italy isn’t that much religious. In average, people go to church and believe in God a lot more in the United States (I know you’re not from there). Italy is a bit more religious than the European average, but that doesn’t mean it’s a very religous country.
I saw a clash of doctors on opposing sides debating the details of Eluana’s state on national television. They said that there was brain activity, unfortunately being a layman I didn’t pay attention whether it was “higher” brain activity or not.
Feb 12 09 8:54 am
Caballaria:
Italy is considerably more religious than New Zealand! An argument based on what value a life in a vegetative state has (such as Maws mentioned) is a deeply religious one, rather than a scientific one. I tend to avoid religious debate on my blog, purely because the debate tends to be highly emotive and reflects a clash of world-views, rather than a rational argument (note that the irrationality is shared by both the religious and non-religious sides of the debate).
Of course, when you have doctors arguing vehemently on both sides of the case, this usually indicates that either the facts are not as cut and dried as one side is making out, or that the argument has already slid into the religious realm. All my information is third (possibly fourth) hand, so I couldn’t say whether the argument was a dispute over facts or belief.