Thursday, August 13, 2015

Whose life is more valuable?

Dr. Arnold Relman, former editor-in chief of the New England Journal of Medicine, professor emeritus at Harvard, and one of the world’s most venerated physicians, fell down stairs and broke his neck last June 27. He was rushed to Massachusetts General Hospital, where he immediately told them who he was. As he recounts in the current issue of The New York Review of Books, “Within a few minutes, it seemed, my cubicle filled with physicians, nurses, and other members of the staff.”
X-rays and a CT scan showed fractures of three vertebrae in Relman’s neck and multiple fractures of bones in his face and skull, with massive hemorrhage around the injuries. The medical team plunged into action. They gave him large doses of adrenal steroids, intravenous fluids, and vitamin K, carefully calibrated to take into account the dosages of regular medication he had been taking.

Suddenly Relman began to choke due to the massive hemorrhage compressing his windpipe. An anesthesiologist tried, but failed, to get a breathing tube into his trachea. A doctor from the surgical trauma team was summoned. He did an emergency tracheotomy, which enabled Relman to breathe.

Then his heart stopped. The medical team immediately did cardiopulmonary resuscitation and administered injections of drugs to stimulate his heart. Within two minutes his heartbeat resumed, but during the next 15 minutes his heart stopped twice more. As Relman writes, “My cardiologist, a senior and much-respected clinician, arrived in the ER just in time to advise the team on their management of the cardiac arrests and the treatment of my rapidly changing heart rhythms and blood pressure. … The resuscitation saved my life.”

Relman was hooked up to a respirator, a catheter was inserted, and more tests were performed, as well as three bronchoscopies to suck blood clots out of his bronchi.

Then he was taken to the surgical Intensive Care Unit. “My wife and our children” he writes, “all gathered at the ICU very late that first night – three physicians and three lawyers, a company that in other hospitals might have bothered the hospital staff. But not here.

“The doctors and nurses kept my family informed and were receptive to their questions and suggestions. … The nursing staff did everything they could to relieve my discomfort. They were always available day and night, and all of them were competent and kind.”

After 11 days in the ICU, Dr. Relman was transferred to the Spaulding Rehabilitation Hospital where he continued his recovery for another month. The total cost of his medical care, almost all of which was covered by his insurance through Harvard’s faculty plan, came to $478,000.

One more detail I have not yet mentioned: When he broke his neck, Dr. Arnold Relman was 90 years old.

If Joe Shmoe, a 90-year-old retired plumber, had arrived at the ER of Mass General after having broken his neck, one wonders what kind of care he would have received. Would the medical staff have mobilized so aggressively to try to save his life? When his heart stopped, would they have resuscitated him three times or, given his age and the possibility that his broken neck might leave him a quadriplegic, would they have hung a “Do Not Resuscitate” sign on his bed? Would his cardiologist have dropped everything and rushed to the ER to supervise his treatment?

I’m sure Mass General is a shrine of compassion for all sick and suffering souls, but would they have suspended the universal rule of no more than two family members in the ICU if those relatives had not been “three physicians and three lawyers”? Would they have been “receptive to [the family’s] questions and suggestions” and “always available day and night, and all of them competent and kind” for a ninety-year-old retired plumber?

Let’s face it: Our society considers some lives more valuable than others. The value we attribute to a particular life reveals the values we ourselves live by.

In the simplest terms, the ultimate value of Western society is productivity. People’s lives are considered valuable as long as they are producing, regardless of what they are producing in terms of its benefit to society...

The value of a person’s productivity has a shelf life. No one would hesitate to resuscitate a 69-year-old retiree who broke his neck, for his productive life is still “fresh.” But 15 years later, we already hear terms such as a “burden to society.”

A person in a coma is the ultimate non-producer. This explains the growing consensus that comatose patients should not be fed, so that they can “be allowed” to die...

The Jewish view of the value of life is drastically different. According to Judaism, a soul descends into this world and dons a physical body in order to accomplish a unique mission and to effect a particular tikkun [rectification].

One’s mission and one’s tikkun are as individual as one’s fingerprint. And just as different fingerprints cannot be rated hierarchically by standards of beauty, so human beings cannot be judged hierarchically or compared...

Thus, from a Jewish perspective, the lipstick plant manager’s life is valuable not because of the 42 shades of lipstick he is producing, but because of the self-discipline he is developing by getting up every morning to go to work and by the kindness he is choosing in the way he treats his workers...

The academician’s life is valuable not because of the research papers she produces, but because of the perseverance she is developing in pursuing her goal and the egotism she is overcoming when she gives proper credit to her research assistants.

I have always considered the most Jewish place in Israel to be not the Kotel [the Western Wall], but Alyn Hospital for severely handicapped children and adults. Most of the patients there can barely move a single limb, are incontinent, and cannot talk. Yet huge resources are expended for their care, and a large, devoted staff works round the clock to lovingly tend to these patients. These are the people whom Hitler would have gassed, considering them worthless. The Jewish view is adamant: Every human life is valuable. Even in the most disabled body, the soul can still accomplish its work.

As long as the soul is in the body (which is the very definition of life), a human being can be effecting his or her rectification. Ninety-year-old people may not be able to do productive work, but they can grow in the trait of gratitude as they accept the services that others render them and can grow in the trait of humility as they suffer the inevitable physical and mental limitations of aging. This inner work is not an epilogue to life; it is the very purpose of life.

The soul is always conscious, regardless of the state of the body. This explains the many documented cases of surgical patients under general anesthesia who later quote comments (and jokes!) made by the medical staff during the surgery. Thus, even a comatose person may be accomplishing much inner “soul work.” Can there be a greater lesson in humility than to be trapped in a body that cannot move or speak? In addition, even a comatose patient accrues spiritual merit by inspiring family members to perform acts of loving kindness for the patient’s care.

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