Paul Brophy Case Study: Bioethics of Right to Die

Introduction

The case of Paul Brophy calls to mind the very similar case of Terri Schiavo and how that case ultimately ended. Mr. Brophy was left in a persistent vegetative state after an artery burst in his brain. His life could technically be maintained through a feeding tube and other medical equipment, but he was not "terminal" in the conventional sense of the word — he was not near death as long as he was being fed. However, medical professionals determined that his chances of ever regaining normal brain function were zero. Given this prognosis, his family wanted to allow him to die, but medical professionals resisted. While this decision may seem straightforward, it raises a number of deeply complex ethical, legal, and moral questions.

Analysis of the Brophy Case

One important piece of information regarding this case is that the events occurred in 1983, with the legal proceedings culminating in 1985. As noted above, the perceived possibility of Brophy regaining consciousness — let alone resuming a normal, functioning life — was considered to be zero. Given this, his family, including his wife, wanted to end his life on the grounds that his quality of life was effectively nonexistent. However, a court-appointed attorney and the hospital asserted that removing the feeding tube and allowing the patient to die was "ethically" and "morally" wrong, characterizing the act as "starving" the patient (Malcolm, 1985). Questions of this nature are central to the field of bioethics (Beauchamp & Childress, 2013).

While some might assume that Christian or similar faith traditions would support sustaining Brophy's life, one notable perspective came from a reverend by the name of John J. Paris, a Jesuit priest and ethics professor. He argued that it was the sustaining of Brophy's life that was immoral. He likened it to propping up a storm-damaged tree that cannot survive on its own and must therefore be allowed to fall. He reasoned that even if the stake supporting the tree is removed, the cause of death remains the wind — not the removal of the stake. By the same logic, he held that the burst blood vessel, not the withdrawal of the feeding tube, would ultimately be the cause of Brophy's death (Malcolm, 1985).

The Chief Physician of the hospital, Richard Field, took an opposing view, stating that removing the feeding tube would be done with the "willful intention of producing this man's death and for no other reason." Field's perspective becomes more understandable when one learns that he had been involved in the liberation of the Nazi concentration camp Dachau. He maintained that starving someone, in any context, is inhumane, and that the staff of the 200-bed hospital would be "devastated" if the feeding tube were removed (Malcolm, 1985).

The Slippery Slope and Euthanasia Concerns

The Christian perspective on this subject is far from monolithic. Another viewpoint can be found in a 2013 article by David Baker published on the Christian Today website. Baker discusses the case of Paul Lamb, a man left completely paralyzed — except for limited movement in his right arm — following a road accident twenty-three years prior to the article's writing. Lamb was conscious but reported living in persistent and constant pain, and he sought to end his life. Baker notes that because Lamb "is incapable of playing any part in ending his life, he is seeking deliberate killing by a doctor." Importantly, like Brophy, Lamb was not "terminally ill" in the strict definition of the term — his life was rife with suffering, but he was not at immediate risk of death.

Baker raises the concern that compassion, while a legitimate factor in such decisions, can open the door to pressure on vulnerable individuals. People who would never ordinarily consider suicide might be pressured by relatives who see them as a financial or personal burden. An organization called Care Not Killing further argued that, while gut-wrenching cases like Lamb's seem to demand a change in the law to permit physician-assisted suicide or euthanasia, extreme individual cases alone do not justify sweeping legal changes that could encompass people in very different circumstances. Those who could potentially be swept into such legislation include people with Down's syndrome, autism, paraplegia, and quadriplegia. Taken to a further extreme, such a paradigm could extend to the socially unproductive, the ideologically unwanted, or the racially unwanted — a pattern that closely mirrors the Nazi euthanasia program and general eugenics ideology.

Noted scholar Alex Schadenberg, author of Exposing Vulnerable People to Euthanasia & Assisted Suicide, warns that "the idea that there are lives unworthy to be lived is dangerous." He continues: "The slippery slope is not imaginary. It exists — and despite the efforts of euthanasia supporters, it cannot be wished away."

Conclusion

In the end, Brophy was eventually transferred to a different hospital that was willing to remove the feeding tube. He was transferred, the feeding tube was removed, and Brophy died in 1986. While the field of bioethics may hold that imposing morality, religion, or any particular ethical framework on others is problematic, it is equally valid for medical professionals to act under the "do no harm" principle, to be mindful of liability when taking actions that end a patient's life, and to grapple honestly with the profound moral weight of these decisions. The Brophy case remains a landmark in the ongoing debate over end-of-life care and the rights of patients and families to make these deeply personal determinations.

References

Baker, D. (2013, April 25). Right to die or wrong to kill? Christian Today. Retrieved October 9, 2014, from http://www.christiantoday.com/article/right.to.die.or.wrong.to.kill/32248.htm

Beauchamp, T. L., & Childress, J. F. (2013). Principles of biomedical ethics (7th ed.). Oxford University Press.

Hodges, L. W., Douglas, M., Kenney, R., Dellert, C., & Caplan, A. L. (2006). An ethics of caring and media coverage of Terri Schiavo. Journal of Mass Media Ethics, 21(2/3), 215–228.

Johnson, M. (2006). Terri Schiavo: A disability rights case. Death Studies, 30(2), 163–.

Malcolm, A. (1985, May 26). A new legal test of the right to die. The New York Times. Retrieved October 7, 2014, from http://www.nytimes.com/1985/05/27/us/a-new-legal-test-of-the-right-to-die.html