The Schiavo dilemma

Abstract

On the face of it, the question of whether life extending interventions that oppose the maladaptive consequences of aging should be provided to those in need, would appear to be easily answered in the affirmative. However, as Jay Wolfson discusses in his essay, there may be occasions when the decision not to sustain life is preferred. This disconnect between the availability of life extending therapies and the decision to use them is generally associated with end-of-life issues. Such cases presently receive significant notoriety because they often involve people who are relatively young. For example, the case of Theresa Schiavo involved a 41-year-old woman who had been in a persistent vegetative state for 15 years. By legal and medical standards, she was considered to be in the same category as those suffering terminal or end-stage diseases, except that it was possible to indefinitely continue her bodily functions through nutritional life support. The decision to provide such support became contentious between those wanting to sustain whatever life was possible for her and those wanting her illness to proceed to its natural conclusion, ie, death. These differing views arose because some people recognized that clinical evidence of her viability was lacking, while others disagreed vehemently with the principle of allowing a human being to die as the result of denying them life support. These issues may become more and more relevant to individuals, their families, and their healthcare providers as advances in medicine allow human life to approach its natural limits. Until science comes to understand and intervene in the actual mechanism by which chronological age leads to physiological incompetence, physical frailty, and vulnerability to disease, death will be the inevitable consequence of senescence. The question then becomes: at what point should interventions in aging be withdrawn during the interim when physical and mental viability end and death is forced upon the body by nature? This question is not answered by Dr Wolfson, but his essay presents the reader with an important perspective for humankind in its quest for immortality.