Is Death the Ultimate Freedom?

Lapius dropped the magazine section of the Sunday Times to the floor, leaned back, made a small chapel of his fingers in front of his mouth, and sighed through the digital arch.

“Triage,” he muttered, “I thought I had heard that term for the last time after the war was over.”

“Well, there’s always a war going on,” I said helpfully.  “Where does the term crop up this time?  Viet Nam?”

“No, in hospital practice.  The term, French in origin, of course, originated during World War I when wounded were brought to the aid station.  They were divided into three groups; the first, those who would recover with no assistance, the second, those who would probably recover with assistance, and third, those who were destined to die no matter what.  Now the term is being applied to hospitals which are chronically short of emergency space and personnel.  So the beds in intensive or coronary care units must be preserved on a sensible basis for those whom the units would help the most.”

“It’s always been like that, Simon.  Why lament about it now?” I asked.

“Because heretofore it has never been given a name.”

“Well, a rose by any other….”

He cut me off abruptly.

“This isn’t a rose, Harry, nor is a hospital a rose garden.  It is the place where Americans expect they will be placed by their physician who will do everything humanly possible to assure their proper care.  Once the matter of the life or death of a patient is ‘institutionalized’ by giving it a name, then the doctor-patient relationship broadens to incorporate community concerns.  In other words, by Triage, we can make do with the facilities we have, instead of building more facilities.”

“Well, there are people who say that would be wasteful,” I said.

“Of course it would be wasteful.  It would waste hospital space and beds; in the meantime it might save lives,” Lapius said.

“You confuse me, Simon.  One day you are complaining that they called a “doctor heart” and brought one of your patients back to life and the next, you are complaining because they want to make choices between those with the best chance of survival compared to those with the worst chance.”

“Aha, precisely.  It is the word ‘they’ that I object to.  Who are ‘they’?  The administration?  The nurses?  Are the decisions to be spur of the moment as the catastrophe develops?”

“Can you think of any alternatives?”  I asked.

“Not good ones.  But perhaps, in certain cases, say an 80 year-old patient who at best can only sit in a chair and gasp for breath – perhaps we should bring the question of heroic measures up, to be discussed between doctor, patient and family.  Frankly, Harry, if I were to drop dead this minute were I able to get out of life so easily and painlessly, I’m not sure that I would want to be brought back - .  And I’m fairly healthy.  Certainly if my health had failed in general and suddenly I “died”, I would not want to be resuscitated – with the risk of possible brain damage at worst, or at best, to return to the life of an invalid.” Lapius said.

“Well, I guess I’ll put you in the third group in the Triage system.”         

“Nothing doing.  I don’t want to be triaged.  I don’t want an official irrevocable decision made about my life.  I want the process to be reasoned, and reversible if events so dictate.  And if I am awake, I would like to have a voice in the final decision,” he said.

“Wow.  Now I am really confused.  You don’t want to be resuscitated if you drop dead; you want a voice in the final decision about whether you live or die.  What is it you really want?” I asked.

“I want my death to be a circumstance of medicine, not an administrative edict.  I do not want crash carts galloping like fire-horses to answer the emergency bell if my heart suddenly stops.”  Then he paused, “Unless of course, I happened to be in the throes of the first moments of a myocardial infarction.”

“There you go again, Simon.  You keep qualifying the manner in which you will die.  You are inconsistent.”

“I would prefer to leave the matter up to my doctor.”

“But your doctor isn’t always around, Simon.  Actually you will have to leave it up to the system in which doctor’s practice.”

“I guess you are right, Harry, but it is an awful thing to contemplate.  Maybe Delbruck was right.”

“What did he say?” I asked.

“He said that we must start to think in terms of educating people to the fine art of suicide, so that they can manage their own destinies before that freedom is denied them by disease.”  He leaned down and picked up the magazine.

“You know, Simon, I have long felt that the Times should drop the magazine in favor of a comic section.”