The ghastly prospect that, as a result of catastrophic illness, doctors might write you off as dead even though you are well aware of what is going on but can’t communicate that you are still alive, is the stuff of nightmares.
Such concern is often expressed about patients in a persistent vegetative state (PVS), but until now this has been pooh-poohed by doctors as fanciful and alarmist.
They have asserted with unchallengeable confidence that the damage to these patients’ brains means that it is physically impossible for them ever again to be aware of anything.
As a result, ever since the landmark 1993 case of the Hillsborough disaster victim Tony Bland, the law has allowed doctors to stop giving such patients food and fluids on the grounds that this permits them finally to die and thus end a ‘living death’.
Actually, since they are not dying, it does nothing of the sort; it is more truthful to call it legalised killing. This objection, however, is brushed aside on the basis that, since they feel nothing, such patients are as good as dead, and protesters are dismissed as cranks or religious extremists.
But now, graphic evidence has been produced that such clinical arrogance is wholly misplaced. A team of Cambridge neuroscientists has reported that a woman who had suffered a severe head injury in a road accident, and seemed unable to communicate or respond to any stimulus, actually played tennis in her head and made a mental tour of her home when asked to do so by the research team.
Doctors said she retained the ability to understand spoken commands and to respond to them through activity in her brain which they were able to monitor and which was the same as the brain activity of a healthy person.
This revelation, which has astounded the medical profession, has the most profound ethical implications. It proves dramatically that even where a doctor pronounces that a patient will never recover consciousness, this certainly does not mean that the patient is dead. And it raises the horrifying possibility that PVS patients may have been starved or dehydrated to death even though they might have felt what was happening to them.
It also calls sharply into question the practice of switching off the life-support machines of others who are in a deep coma. The fact is that these patients are alive, and the Cambridge experiment rubs the doctors’ noses in this most inconvenient fact — one that they have tried so hard to deny.
The case exposes the total absence of humility of a medical profession that pretends to know what it cannot possibly know. Much that goes on in the brain, especially around the issue of consciousness, remains utterly mysterious and unexplained.
Yet doctors arrogantly assume that they know enough about the brain not only to declare that their patients will never recover any sensation but, worse still, that in some cases they are actually dead.
This has implications even more sensitive than for sufferers from PVS. For the medical definition of ‘brain-stem death’ underpins organ donation, which gives people who would otherwise die of chronic disease the chance of gaining a healthy life through an organ transplant.
A new law that has just come into operation has deprived relatives of their power of automatic veto over the removal of organs from loved ones who carried donor cards. This is aimed to tackle the chronic shortage of organ donors, which means that every year some 500 people die waiting for a transplant.
Doctors will now be able to override relatives’ objections unless they feel that these are overwhelming. But relatives are often reluctant to give their consent for organs to be removed because they see that the body of their loved one remains healthily pink and with a heart that is still beating.
The philosopher Baroness Warnock, that self-appointed national arbiter of where life begins and ends, says such squeamishness is inevitably based on ‘irrational sentiment or irrational dogma’. But this is simply as ignorant as it is offensive.
For the fact is that the medical profession has redefined death purely for the benefit of the transplant programme. It has defined the point of death as the failure of the brain-stem to respond to certain tests, with the resulting additional diagnosis of the irreversible loss of the capacity for consciousness and the capacity to breathe.
But testing the brain-stem cannot exclude all possibility of recovery in every case — not least because it does not test the higher parts of the brain that may still be functioning. That is why, as a recent report from a German neurosurgical unit revealed, two of their patients diagnosed as brain-stem dead actually ‘recovered’. In other words, they were not dead at all.
Moreover, some anaesthetists who paralyse ‘brain-stem dead’ patients to enable their organs to be removed give them a general anaesthetic as well— just in case they may still have some feeling during the procedure.
Whoever heard of anaesthetising a corpse to avoid the slightest chance of causing it pain or distress? This in itself demonstrates that, even for doctors involved in organ removal for transplant purposes, the definition of death is wholly artificial and even meaningless.
Yet such is the pressure of the transplant programme, they insist on ignoring or even denying the considerable body of evidence giving rise to such doubts within the profession. The Royal College of Anaesthetists recently upheld the brain-stem death definition and repeated the claim that is frequently made in such circles that ‘death is a process rather than an event’.
But this is absurd. Dying is a process; death is indeed an event. The distinction has been blurred simply because death has become too inconvenient. Organs for transplant cannot usefully be extracted from the dead, so they are being taken instead on occasion from people who may at most be dying —at which point the ‘event’ of death certainly does take place.
Of course, it is a noble ideal to save the lives of those who are desperately ill. And some whose organs are harvested are undoubtedly dead. But what if the transplant programme does not always take organs from corpses but from living people who are actually killed by this process — and more horrifying still, may even have some awareness of their surroundings?
The uncomfortable fact is that we have redefined our understanding of death so that it no longer applies in circumstances where life has become too inconvenient. Our society no longer believes in absolutes — even those such as life or death — if they stop scientists from fulfilling their promise to deliver happiness to all.
Thus when the traditional understanding that human life begins at conception started getting in the way of embryo research, which was said to benefit infertile couples or help find a cure for genetic disease, Lady Warnock obligingly and arbitrarily shifted the start of life to 14 days’ gestation.
Thus, when the traditional understanding that death occurs when the heart stops beating started preventing organs being harvested for transplant purposes, doctors redefined the point of death as the failure of the brain stem instead.
Medical science, in other words, has been playing God. The Cambridge experiment has demonstrated just how horrifyingly wrong that was.