Kenneth Schemmer's ethical analysis of life support decisions and end-of-life care

¶ … Life and Death: The Life Support Dilemma by Kenneth E. Schemmer M.D

Kenneth Schemmer in his thorough, thought provoking book brings to life the controversial subject of the life support issue. For years, many all over the country have pondered, "What if a person were in some kind of an accident and the physicians told them that they were not going to make it?" And all that he or she could do is just lie there in extreme pain waiting for their life to the end. Or even worse case scenario what if they happened to end up completely brain dead? These debated questions are taken on by Dr. Schemmer in making his point that life support decisions may not necessarily be the decision of the family, the doctor or the patient but by a higher being that gives life and takes life. Schemmer uses these controversial questions in his book to give a point-of-view that has been left out by many, God's perspective. Though this point-of-view has been evaded by many experts, physicians and family members, it is clear that Schemmer does a very thorough job in opening up a can of worms that many do not want to face when it comes down to life support of a patient. Death, dying and other moral dilemmas are issues that all doctor and families throughout the world have to face and address one time or another. This subject is so controversial because believe it or not, different people have different beliefs as to what life support actually means. Most experts such as Schemmer word, describe Life support is when a person is being reserved alive for the reason that they have one or more major organs or organ systems that are either not answering or do not work at all. People who have these problems need life support to help them stay alive.

However, the debates pour in when so many different people decide to play God and choose to take matters in their own hands, thus determining the fate of the poor individual. In the eyes of those that are evangelical Christians, it would be sending a soul into eternity without even bring the matter to the throne of God. However, with others it would be an issue of not being able to keep them on because the lack of financial means or just the idea of watching someone suffers in incredible pain.

A lot of American believes that there are definite conditions where it should not be reflected murder in aiding someone with their dying process (John-Thor Dahlburg., 2004). For instance, if a person is in pain and is told that they just have a brief time before they will expire and that during those days that the discomfort will intensify. A lot of Americans really feel that they should have the right to choose if they would want to live the rest of the time with the discomfort or end it by means of medical methods (John-Thor Dahlburg.,2004). Many people believe that it is wrong to make someone suffer that way when they can just go in peace. Others state that if someone is said to have no brain activity at all, then they should not be made to live their lives that way.

Nonetheless there are many that also feel that taking someone off of life support is just plain murder. This is view is shared by the fact that taking someone of off life support is basically taking their life away. They base this assessment on the fact that when people eliminate the machine then they eliminate the person because that is all they have to hold on to.

Schemmer does a very sound job in bringing up the point that these are horrible conditions and that no individual should have to watch their family member go through such a horrifying ordeal. Fortunately, Schemmer is not alone, with so many Americans concerned with this issue; many believe that no family member should have to go through such an excruciating and depressing event. Then again, many of same individuals do not believe that this horrifying event should be put in the hands of a higher Power since a lot of people do not believe in the divine power of healing. It appears that this issue has really divided the nation among those that believe that the patient has the right to just end their life and those that hold on to the belief that God is the one in control and only HE can make that divine call. With that said, the purpose of this paper is to give a thorough analysis of Schemmer point-of-view that the debate that "People have a right to do with their own body as they see fit" does not really hold up.

Summarization of Between Life and Death: The Life Support Dilemma

Dr. Schemmer states opens up a can of worms that get the reader to see another side of the life support dilemma. However, he does this by using very informative information regarding the Christian point-of-view by basically employing what God would have to say about the issue. The book was very revealing because Dr. Schemmer makes the statement that the line that goes between life and death has become a little unclear due to the fact that people really do not have rights to their own life and that God holds that liberty. The author does a well written job at showing the readers how many doctors all over the world have basically come up with creative ways to basically play God with their patient's lives. He uses fascinating examples of how man has come up with advanced technology to extend physical life. However, the most fascinating and thought provoking subject was that of Euthanasia, which he describes as the mercy killing. The book does a tremendous job in explaining how it is the practice of medical doctors that painlessly take it upon themselves to put to death a person that has a terminal, excruciating, or disturbing disease or life threatening illness without the consent of anyone. However, he is carful in informing the readers regarding the negative and positive euthanasia.

Schemmer brings a lot of informative issues to the table. For example, Schemmer makes stimulating descriptions in describing how the positive euthanasia is supposed to refer to an action that is really taken in order that the person is able to end the life of a person, while on the other hand the negative euthanasia is what proposes the concealment of medical events or treatments that are from a patient that would be essential in order for the patient to live. In this point, he uses the opinions of others to support the belief on this issue and brings to light the seriousness of this subject. The author makes sure that this information gives them the insight glimpse of a form of killing that is dividing the nation.

It is clear that the subject of euthanasia was dear to the author due to the educational material that he goes on to provide regarding the issue. For example, when dealing with the subject of euthanasia, the author does a real thorough job in breaking the matter down in a separate chapter. In that section, he discusses how this subject has clutched the responsiveness of the country ever since the aided suicides that were mostly achieved by Dr. Jack Kevorkian, who was responsible for killing many patients. Schemmer states his subjective views on this matter as he gives insight on how this was merciless killing that many view as necessary slaughter. Regarding this serious matter, he brings up the point shared by many of asking whether or not a doctor really has the right to "play God" and finish the life of a patient who is demanding that they want their life to come to an end.

There are many places in the book where Schemmer spends a lot of time on making sure the opinions of other are voiced. Good or bad Schemmer does an excellent job by not being judgmental but actually respecting their views. He does a detailed job bringing up the point that as Americans living in a free nation, given the choice to put an end to the suffering of a patient for whom death is unavoidable, appears not to be that radical in wanting to see things change. Schemmer does a well-written job in depicting the suffering of a patient and how painful it is for anyone to observe. He goes deeper in mentioning the much heated debate that a person who is suffering and lying on his deathbed waiting to die has the right to put an end to the misery. The book makes the point since euthanasia is permitting the patient to have right to die with self-respect, and is supposed to be helping them by relieving the stress of mounting charges of medical prices for the dying, and allowing human nature to just take its course. The author even goes on further with some ideas of how the legislation needs to be really being changed in order to lawfully inspect and receive circumstances of euthanasia.

The book also goes on to talk about many other areas to the reader for example, how this misrepresenting of the border line has left a lot of people with sensitive questions about pain and suffering and how it not only effects the patient but also people around them such as their family and friends (Schemmer, 1998, p. 83 paragraph 2). Schemmer goes a little further and discusses other topics such as the quality of life, death with dignity, and the costs of long-term care. He mentions that people can really discover many different helpful answers to these queries and answers that are learned by God's word and what he feels about the situation rather than relying on the human flesh for the way to deal with problems such as life and death. The author brings up the point with reference to the compassion of Jesus, and our Christian conscience and how it should play a very crucial role in the decisions that we make. He looks at questions for example: The growth of contemporary medical technologies and the impact that they have on our society. He also jumps in to the legal aspects of cases that are current and their effects on patient's decisions. It is clear that the author wants to show what it means to be a person. What he, a doctor would want for myself went put in these situations.

Theory-Autonomy

It is clear that Schemmer made the point of autonomy. In our selfish society, autonomy (independence and self-government) obtains great stress. However, autonomy is barely ever done deprived of limits. Clearly, any society and that included those places that do not even recognize God's moral laws really do need to put some restrictions on personal in for everything that everything can function correctly. Schemmer makes the point by making sure the reader understands that Biblically, our distinctly autonomy must be imperfect by God's moral law.

As talked about in the book people that practice being secular humanists of course refuse this as being truth. They state that the privileges of any patient are superlative and that has a right to select the nature and time of their own death. This adds up to death that is put on demand. Nonetheless even if we came to the agreement with the autonomy argument, being tolerant of that person should be allowed to select death on demand, with conviction such a choice would require some kind of competence, informed permission, and voluntariness (Dolan, M.,2001). To be truthfully autonomous, an individual choice has got be rational, fully-knowledgeable, and easily made. Are people that are terminally=ill really in a state of mind to even make such a choice? Most would argue not, bearing in mind that their mental capability is affected by fundamental illnesses in 75% of cases, and that emotional capability is often affected by a preliminary, but revocable, stage of suicidal depression (Gostin, L.O.,1997). Furthermore, fully-informed agreement is frequently complex by doubts of analysis and prognosis. Physicians are just powerless to precisely forecast the timing of death or the value of lingering life and may suggestively mislead terminally-ill patients (Gostin, L.O.,1997). A further complication that Schemmer points out is that the voluntariness of a person's selection may simply be cooperated by stresses from medics, nurses, family and the world - all of whom have conferred interests which could tussle with the patient's survival (Schemmer, 1998, p. 83 paragraph 2).

Other studies do show that a counter-argument made by euthanasia advocates is that an organization of concentrated counseling and far-reaching assessment could defend the development - for example the rules for euthanasia in different places around the world. Nevertheless, a government ordered study into the use of euthanasia in the Netherlands had shown that the rules are not always shadowed: A third of lethal injections are done where the patient is unaware, and in spite of the requirement for determined request, 57% of circumstances happen on the same day they are requested for, and 10% occur during the same hour! (John-Thor Dahlburg.,2004) The study presented that physicians also often fabricate death certificates and ignore the desires for referring a second physician.

Personal Opinion

As the researcher coming from a Christian background, his views are very similar to Schemmer. In the researcher opinion, the Christian perspective on the subject of "assisted suicide" is really quite simple. The researcher like Schemmer believes in the holiness of life from the instant of beginning up to the point of natural death. There are roughly 65 passages of scripture in the Bible that communicate to the holiness of life, starting with "Thou Shalt Not Kill." In the end, the researcher believes that God is the one that provides life and the one that can take it away and that His will in such substances takes superiority over man's determination. The researcher believes in the Christian view that is constant with the Declaration of Independence, that God has gifted us with definite unalienable privileges, and amongst these is life. The believer believes that Life is basically the first right. Without this one, any others are deprived of effect.

The researcher agrees with Schemmer as he makes the point that our society is progressing in the direction of a culture of death, the supposed "right-to-die" will eventually become an responsibility-to-die, for instance, for anyone who trusts that they are a problem to someone else -- either economically or whatever the case. The author makes a very intriguing point when it comes to the will of the patient by mentioning, "When someone is considered useless to themselves and a burden to society, the "right to die" will become the "duty to die." And in the researcher's opinion, by what basis would the tendency be limited even to that? (Schemmer, 1998, p. 125 paragraph 1)The consequences are frightening, but completely rational. For instance, what is to keep a distressed adolescent from trusting that suicide is a something normal to choose? The researcher agrees with Schemmer regarding that fact that Christ says choose life. Life is appreciated from its start to the normal end.

As regards to theories, the researcher supports the theory of deontology because it does uphold open lines of communication with the patients so that the patient will not be left in the dark and they are able to come to a conclusion together. The researcher believes that the doctor should determine that the patient comprehends their situation concerning their life threatening illness and the consequences of refusing treatment which put them on life support. The researcher believes as outlined in the book that the doctor would need to advise their patient that in all sensible likelihood that their condition will worsen to a rank in which she will be incapable to care of themselves and at that time they should be able to include the family members in making the decision but if they are Christians, it would be wise to go to God first. However, the researcher believes that the book failed to really represent that point further. The author seems to dwell more on the issue of doctors and family members pulling the plug rather than exploring these theories more as the correct protocol for making any decisions.

The researcher believes that Schemmer failed in displaying more on how the doctor is supposed to execute an advance medical instruction so that patient's wishes with respect to treatment will be respected. The research understands that in western civilization, a patient is supposed to be entitled to the standard of care presented in the area where they choose to be treated; however, in Shimmer's book, he failed in not really showing us how the patient is subject to the guidelines of the health care facility, as well as her confidentiality and privacy privileges, regardless of cultural differences (Schemmer, 1998, p. 83 paragraph 2).

Schemmer final position was that God is basically the God is the one that is in charge. He clearly makes it clear that no man has the right to take the matter of a patient's fate in their hands, clearly when they are in a state where they are completely unaware.

Conclusion

As Christians, the author would state that we are called to be the light and salt within our environments of influence. Schemmer basically states this theme throughout his book. The Bible makes this point clearly in his defense. Fascinatingly, a Christian Nobel Prize winner, once stated: 'The world supposes for Christians that they will make their voices be known so loudly and evidently and so express their complaint that not even the humblest person would ever have the slightest hesitation about what needs to be said. Schemmer was able to do that with voicing his view on the life support issue. Further, the world really puts the pressure on Christians in expecting that they themselves will avoid all uncertain concepts and plant themselves resolutely in the center of the horrors of history. The book portrayed the views of a person that was willing to stand in need of people who has determined to speak openly and obviously and anyhow, to stand by what they have spoken.' Christians must, no matter the situation, will need to always oppose euthanasia by confidently announcing God's word of truth, and on the other hand, endorse life through a hands-on protest of His love and compassion. Even though the book describes how the Death by choice supporters also dialogue about limiting euthanasia to the hard situations, for instance the terminally ill with 'intolerable' suffering, it is clear that even limitations are not satisfying to the problem. Dr. Schemmer explains that they know that if the ban against murder is taken away for one group of individuals, it will put people through a slope towards letting it be for others. Then everything turns into a case where if it may be right for some people than it might as well become a right for everybody else. In reality, the safeguards are really merely a cover-up for death on demand; much the same way abortion is for the sake of the mother's well-being showed to be a cover-up for abortion on demand. As far as autonomy goes - the privilege to choose -- has got to be restricted as Schemmer would agree; some selections are basically just biblically wrong and/or objectionable, and it is very obvious that as the proclaims, must declare God's truth in this specific area. In argument and discussion, we need to also bring to light that even if autonomy were a standard, when examined, it cannot in any form or fashion validate euthanasia.

References:

Court backs right to die | terminally ill have right to refuse medical life support. (1984, Dec 28). The San Diego Union, pp. A.1-1.

Ackerman, T. (2005, Mar 27). Life support battle shifts / A decade ago, patients families had to press for 'right to die. Houston Chronicle, pp. 1-B.1.

Allen, P. (2000, Oct 07). Right to die upheld despite new euro law, doctors can end life support rules judge. Daily Mail, pp. 33-33.

Dolan, M. (2001, Aug 10). Justices deal setback to right-to-die movement; health: State court bans removal of life support from conscious patients whose wishes are not clear. Los Angeles Times, pp. A.1-A.1.

Gostin, L.O. (1997). Deciding life and death in the courtroom: From quinlan to chiav, glucksberg, and vacco -- A brief history and analysis of constitutional protection of the right to die. JAMA, 278(18), 1523-8.

John-Thor Dahlburg. (2004, Sep 01). The nation; Florida justices start review of right-to-die case; the essential question here is: Who is entitled to make a decision on something as personal and private as whether to use life support? Los Angeles Times, pp. A.10-A.10.

Kaplan, K.J. (2007). Zeno, job and terry chiavo: The right to die vs. The right to life. Ethics & Medicine, 23(2), 95-102,67.

MARTIN KETTLE, I.W. (1999, May 20). Woman shot and paralysed by mother wins right to die she had her life support machine switched off, but first she told the police how her mother murdered her. The Guardian, pp. 17-17.

NESSMAN, R. (1996, Apr 07). Karen Ann quinlans parents reflect on painful decision 20 years later; impact: Since the courts ruled they could remove daughter from life support, right-to-die movement has gone mainstream. Today, about 75% of Americans die in institutions, many after decisions to withhold life-sustaining assistance. Los Angeles Times (Pre-1997 Fulltext), pp. 7-7.

NESSMAN, R. (1996, Mar 31). Landmark right-to-die case turns 20 quinlans decision to take daughter off life-support equipment first to draw country's attention. Journal Star, pp. A.1-