For the past 20 years the Texas Advanced Directives Act (TADA) has inexcusably traumatized human life. Fully cognizant patients who have explicitly communicated that they do not wish to die have been removed from all life sustaining treatment and left for dead. Despite pleas from patients and their family, unelected, nontransparent hospital “ethics committees,” fully immune of any consequences, are given complete authority to remove all life-sustaining treatment and leave patients to die as they beg for their life. These ethics committees are not required to give any reason or justification for their decision and no chance of appeal is allowed for patients and their families.
Many elected officials have deemed this act “unconstitutional” as convicted child rapists and murderers are given more rights to appeal their fate before elected officials than patients are under the Texas Advanced Directives Act. It is called “10-day rule,” colloquially named as patients are given 10 days to either be removed from life-sustaining treatment or transferred to another facility that is willing to take them. Understanding what all is at play to enable the Texas legal system to settle on such a horrific perspective is no doubt a multifaceted problem. From the ethics of indifference to evil, to one “just doing [their] job,” there is plenty of room for discussion and input from multiple disciplines on how this should be addressed.
The intentions of the personnel involved in such decisions may be based on the empathy to not give “false” hope, or not to continue with “futile” care. Though there is little evidence of this given the lack of transparency in these situations, I am willing to give a large benefit of the doubt that hospitals are not killing fully cognizant patients in 10 days to free up rooms for better insured, more profitable patients. To make the claim that removing life support against the wishes of the family and their patients is a “mercy” is, in this researcher’s opinion, unscientific narcissism that clearly crosses a line when it goes against the wishes of the families or that of the fully cognizant patient.
Making predictions
Medicine doesn’t make testable predictions with certainty. To be clear, I am not discounting medicine for the role it plays in making our quality of life better, but serious problems arise when we start masquerading medicine as something it is not. The stochastic, chaotic, and nonlinear nature of living things becomes too complex for anyone to make predictions with certainty.
As a researcher, I have done controlled experiments on genetically identical mice. Despite doing everything I could to make sure I set up my experiment correctly, I would, at times, get different results. Sometimes these differences were significant, sometimes they were not. Lest you think I am just overlooking the details of my own work, I will remind anyone who reads this article that even genetically identical mice can have significant variations in phenotype due to variation in how epigenetic modifications are carried out.
If I failed to make precise predictions on genetically identical mice under well-controlled experimental conditions, what right do physicians or hospital “ethics committees” have to make claims on genetically unique individuals in non-controlled settings?
Taking a lesson from history
The situation becomes more complex when we consider the fact that historically, the definition of life and death has never been very clear or well-defined. We do not have a concrete definition of life, nor that of consciousness. This lack of a clear definition has caused numerous problems throughout history. Going back to the middle–ages all the way through the Victorian era, many of the “deceased” were in fact, still alive at the time of their burial. Discovering signs of struggle on the inside of coffins is what led in part to the common mythos of the undead such as vampires. Fast forward to the present time, and the discovery of new frameworks for assessing and defining consciousness and life have revealed harrowing details.
To give one example of many, there is a condition known as Locked-In-Syndrome that paints another vivid horror story. Patients who suffer from this debilitating condition are fully awake and conscious, but due to either trauma or infection there is damage done to a specific area of the brainstem that results in complete paralysis of all voluntary muscles, except those of the eyes. Although locked-in syndrome comes with incredibly severe challenges, some research suggests that the patients’ quality of life is significantly better than anticipated. Some can go on to write books detailing their experiences. Tragically, many patients with Locked In Syndrome and other analogous conditions do not “respond” to stimuli and are often mistaken as being in a “vegetative” state, and murdered by means of termination of care. This form of evil (no other way to describe killing someone who is conscious enough to write a book) stems mainly from the fact that physicians and hospital admins are the only personnel arrogant enough to make a decision based on something that they do not understand and cannot define, let alone quantify.
History paints the picture of numerous discoveries that push the line between life and death back ever further. We should pay very close attention to this historical trend before we continue to give “ethics committees” the right to end life-sustaining treatments.
