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"The idea of not prolonging life unnecessarily has always been more widely accepted outside the medical profession than within it," says a leading Protestant (United Church of Christ) theologian, University of Chicago's Dr. James Gustafson. "Now a lot of physicians are rebelling against the triumphalism inherent in the medical profession, against this sustaining of life at all costs. But different doctors bring different considerations to bear. The research-oriented physician is more concerned with developing future treatments, while the patient-oriented physician is more willing to allow patients to make their own choices."
House-staff physicians, says Tufts University's Dr. Melvin J. Krant in Prism, an A.M.A. publication, "deal with the fatally ill as if they were entirely divorced from their own human ecology. The search for absolute biological knowledge precludes a search for existential or symbolic knowledge, and the patient is deprived of his own singular humanism." The house staff, Krant says, assumes "that the patient always prefers life over death at any cost, and a patient who balks at a procedure is often viewed as a psychiatric problem."
Technical wizardry has, in fact, necessitated a new definition of death. For thousands of years it had been accepted that death occurred when heart action and breathing ceased. This was essentially true, because the brain died minutes after the heart stopped. But with machines, it is now possible to keep the brain "alive" almost indefinitely. With the machines unplugged, it would soon die. In cases where the brain ceases to function first, heart and lung activity can be artificially maintained. While legal definitions of death lag far behind medical advances, today's criterion is, in most instances, the absence of brain activity for 24 hours.
The question then, in the words of Harvard Neurologist Robert Schwab, is "Who decides to pull the plug, and when?" Cutting off the machines−or avoiding their use at all−is indeed passive euthanasia. But it is an ethical decision−not murder, or any other crime, in any legal code. So stern a guardian of traditional morality as Pope Pius XII declared that life need not be prolonged by extraordinary means.
But Pius insisted, as have most other moralists, that life must be maintained if it is possible to do so by ordinary means that is, feeding, usual drug treatment, care and shelter. This attitude is supported by history. It would have been tragic, in 1922, to hasten the end of diabetics, for the medical use of insulin had just been discovered. Similar advances have lifted the death sentence for victims of hydrocephalus and acute childhood leukemia. But such breakthroughs are rare. For the aged and patients in severely deteriorated condition, the time for miracles has probably passed.