Redefining Sedation into Killing

By Wesley Smith - March 26, 2013 - Link to the original article.

Wesley Smith

There is an ongoing–and potentially lethal–discussion ongoing in bioethics and moral philosophy that would redefine death from the irreversible cessation of cardio/pulmonary function or neurological function, to a diagnosis of permanent unconsciousness. But the unconscious breathe and their bodies function, meaning that they are clearly not biologically dead.

But logic and accuracy are impediments to the agendas being pursued. Indeed, redefining death would break the back of the sanctity/equality of life ethic permitting the fulfillment of several (dire, from my POV) long-time utilitarian societal goals:

• Destroy human exceptionalism by denying intrinsic human dignity;
• Make the value of human life subjectively depend on quality of neurological function. e.g., “personhood theory;” 
• Allow the profoundly cognitively disabled to be organ harvested before biological death, in essence killing for organs; 
• Allow experimentation on living human bodies under the pretext that they are mere cadavers; 
• Stop all medical care, as now happens with those declared dead, to save resources. 

Now, I can add a sixth purpose (or consequence); breaking the general prohibition against active euthanasia.

Heretofore, the redefine death crowd have primarily limited their targets to those with profound and permanent cognitive disabilities caused by injury or disease, such as the late Terri Schaivo. But now, an article published in the Journal of Medicine and Philosophy, (38: 190–204, 2013) by Samuel H Lipuma, argues that permanently sedating a dying patient–a legitimate palliative technique, rarely required–is the same thing as euthanasia. From the article:

The thesis being defended here is not just that there are many similarities between CSD [continuous sedation until death] and PAS/E physician-assisted suicide/euthanasia] but rather that CSD is equivalent to PAS/E. CSD, as it has been defined and clarified here, is the permanent elimination of consciousness from a patient. To have one’s consciousness permanently eliminated is to die. It is a death of higher brain functioning.

Note that it isn’t as if the patient’s consciousness couldn’t be restored. It is that doctors don’t plan to do so because the patient would be in intractable pain. (Also note that most cases–perhaps all, I don’t know–of palliative sedation don’t actually require permanent sedation until death as a matter of medical necessity. That it is sometimes done that way, doesn’t mean it has to be.) Also note that the sedated patient’s body continues to function, often without medical assistance such as a respirator. Thus, by any objective measure, the patient is not dead.

Nor is permanent unconsciousness the same thing as “brain death,” since death by neurological criteria requires that every function of the brain and each of its constituent parts cease functioning as a brain (not that every brain cell be dead). The brain of a sedated patient has not ceased functioning as a brain. The drugs have merely rendered the patient unconscious.

Not only that, but supposed permanent unconsciousness isn’t necessarily unaware. There have been many recorded instances of unconscious patients, with no seeming higher brain function, recalling precisely what happened during that time. And recent neurological screening breakthroughs have shown that some supposedly permanently unaware patients are able to interact. Heck, we don’t actually know what consciousness is!

Back to Lipuma. He, and his ilk, seek to redefine death from a biological into a sociological meaning, from a condition that can be determined (at least theoretically) objectively through medical means, to a subjective approach in which death to one person is not death in another. From his conclusion:

The thesis being defended here does not involve moral evaluation. It claims that CSD is indistinguishable from PAS/E. To say that CSD occurred would be to say that killing occurred. That does not make it immoral because context determines when killing is or is not justifiable. Self-defense involves killing but is morally justifiable. CSD is also morally justifiable because it rests on the principles of respect for patient autonomy, mercy, compassion, and physician nonabandonment…

The present concern is to demonstrate the claim that no significant differences can be made between acts of CSD and those of PAS/E. For those insisting that life and death should be understood biologically,the case could be made that CSD is not death. This can only be done at the expense of a definition of death based on consciousness and all other human awareness and instead forces us into a much less desirable “one size fits all” notion of death. This does not do justice to being human and the significance that consciousness and all other human awareness abilities have to human life.

Identifying CSD with higher brain death is a more precise and accurate characterization of what occurs. Clarifying our actions to the greatest possible extent should help us improve the care of the immanently dying. That is the fundamental inspiration behind this analysis.

Like I always say: If you want to see where the culture is going wrong, just read the professional journals.