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Where the road ends
Academy Award-winning films and the much discussed Schiavo case bring the heavy and emotional topics of treating terminally ill, whether to stay on life support and euthanasia to the forefront

By Magin McKenna
mmckenna@thenewsstar.com

When Elisabeth Grant-Gibson recalls her late mother's refusal to allow a surgeon to amputate a gangrene-infected foot, she scales a thorny resolution that affects countless relatives of the terminally ill.

"It's a path to death," said Grant-Gibson, of Monroe. "And you know you are embarking on it."

The moment Grant-Gibson's mother declined treatment, she accepted her life's end.

While many families prickle with pain and frustration when a loved one refuses treatment for a terminal illness, "Million Dollar Baby" contemplates a rarer end-of-life issue: euthanasia.

The film, in its first weekend in Monroe, asks profound questions about a person's right to choose death.

Who may end a life? And when is it morally justified to do so?

As it considers Oregon's Death with Dignity Act later this fall, the U.S. Supreme Court will ponder those same questions on the issue of physician-assisted suicide. The court earlier this year refused to hear arguments on a Florida law to keep a brain damaged woman, Terri Schiavo, on life support.

But there are extreme moral differences between a dying person refusing treatment for a terminal illness, euthanasia and physician-assisted suicide, Grant-Gibson said.

Still there is an achingly similar end, she added: "All roads lead to death.

"What is very different is when the person is conscious, aware and making the decision, it's much easier on the family," she said. "When the person is unconscious, it's constant second guessing."

In its treatment of euthanasia, the Academy Award-winning "Million Dollar Baby" has drawn the ire of Catholic groups, and some criticism from the Center for Bioethics and Human Dignity in Chicago, Ill., which posted an unfavorable review on its Web site.

Without giving the film's ending away, a hospitalized character asks to be euthanized. But the same character accepts treatment that prolongs life — which would not necessarily happen in reality.

"The patient has the ability to refuse treatment," said the Rev. Charles Barley, chaplain at Glenwood Regional Medical Center in West Monroe and co-chair of the hospital's ethics committee.

"That's the patient's right," he said.

The Bible, too, asks questions about morally permissible killings, the most notorious being Abraham's near-sacrifice of his only son, Isaac.

While the binding of Isaac is not literally the same as euthanasia, the themes are resurfacing in popular television, film and culture, said Bob Thompson, director of the Center for the Study of Popular Television at Syracuse University.

"The 21century is going to be so much about biotechnological questions that back right smack up against moral and ethical issues," Thompson said. "When 'Million Dollar Baby,' with a theme of euthanasia, ends up in best picture, it's evidence that these films have the ability to emerge in the most mainstream of places."

Last week "The Sea Inside," a film that examines a quadriplegic's right to die, won best foreign film at the Academy Awards. Add that to "Million Dollar Baby," heated debates in Florida and Oregon and recent legislation in Europe that legalizes euthanasia in certain circumstances. The result brings a new dilemma to medicine, said Dr. Samuel Hensley a fellow at the Center for Bioethics and Human Dignity.

When doctors can't save dying people, should patients have the option of asking doctors to help them die?

"Doctors should never be put in the position of deciding between life and death," said Hensley, a physician at Mississippi Baptist Hospital in Jackson, Miss. "The benefit is that we can look at what's happening in the Netherlands and Belgium, where euthanasia is legal, and turn to people regardless of their religious persuasion and say, 'Is this the kind of country you want to live in?'"

But Hensley said it is common for doctors to remove patients from life support when a patient has requested it. In those situations, doctors are not deciding death, he said.

"That's removing extraneous life support that the patient doesn't want and leaving it in God's hands," Hensley said.

Families can avoid emotional trauma by encouraging patients to write specific living wills that detail end-of-life desires, he suggested.

Also common is for doctors to withhold food and hydration from a dying patient, said Dr. Charles Mason, medical director for Hospice Care of Louisiana. In those cases, water and food are hurting the body, he said.

Many times doctors administrate narcotics, such as morphine, to alleviate extreme pain in the terminally ill, Mason said.

"We don't do anything with the intention of purposely causing death," he said. "When I give medicines like morphine, I give them for the purpose of treating a symptom that's causing distress."

Withholding intravenous fluids from terminally ill patients can hasten death, but Mason said it does not ultimately cause death.

"Cause of death to me is still terminal illness," he said. "These are people that, no matter what, are going to die."

Recently the issue of withholding food and hydration raised concerns for the Roman Catholic Church. Pope John Paul II stated a church position in May 2004 that called intravenous nourishment morally obligatory as a natural means of preserving life.

The Catholic Church allows for a dying patient to be removed from life support when life is sustained artificially, said the Rev. Mike Haney of St. Paschal Catholic Church in West Monroe.

Such cases, he said, allow room for divine intervention.

"A person could start breathing when a ventilator is removed," Haney said. "We don't know when termination of life is going to come, and that determination should come from God."

Originally published March 5, 2005

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