Monday, July 22, 2013

The Right To Die. Maybe. Sometimes. If You Don't Change Your Mind. Today.

Great article in the New York Times Magazine, called A Life-or-Death Decision, by Robin Maranz Henig, about an ethicist Peggy Battin, who teaches and writes on the right to self-determination and end of life decisions.  Her husband, also a college professor, suffered a severe head injury while bike riding, leaving him a wheel-chair bound, machine dependent quadriplegic, a year after he'd written a living will forbidding the use of "measures to unnaturally prolong or postpone the dying process."  In the years since the accident in 2008, her husband, Brooke Hopkins, has required around the clock care to maintain his breathing, a feeding tube, and an enormously expensive motorized wheelchair for mobility, and a quarter of a million dollars a year spent on 12 aides who help him around the clock.  He's been in and out of the hospital, and what's striking is that from the time Dr. Hopkins wrote his advance directive, he changed his mind.  Now the couple struggle with the dynamic that sometimes he says he wants to die, his wife ignores his requests because she believes he doesn't really mean it, and generally he later says that in fact, he's glad measures were taken that kept him alive.  Dr. Brooke is able to read with a voice-commanded computer screen and co-teaches a courses in his home.

I'm all in favor of advance directives and the right to die with dignity in a situation where healthcare prolongs the inevitable death.    This story, however, was extremely confusing.  One member of the couple is a bioethicist whose career has revolved around these issues.  The other is a gentleman with a head injury, an impaired lifestyle requiring extreme measures of support, a general (or so portrayed) happy and positive outlook who is still culling meaning from life and contributing to society, and yet, there is no absolute way he can say "enough" ( he tried in a Final Letter) because any such statements are felt to be transient, reflective of a momentary state of distress that will pass, and so in a Catch-22, it's not quite clear that he can ever practice what his wife teaches.

I will mention that the article had a single passing reference to the fact that Dr. Hopkins (Ph.D. from Harvard, athlete, risk taker, life of the party, and esteemed college professor) suffered from bipolar disorder, and aside from that single mention, it was never part of the discussion as to why he shouldn't call the shots on his life, have an advance directive, or called into question as a reason why he might be changing his mind about wanting to live or to die. Bipolar disorder got a mention, but it does not sound to be what defines Dr. Hopkins.

So what do you think?  How do we ever really know for sure what someone wants if they change their mind or waiver during moments of crisis?


ItsTheWooo said...

Not surprising. As a nurse I see selfish family members all the time; they keep loved ones alive because they'd rather someone rot in a bed and suffer stage 4 decubiti and stare at a ceiling for days on end with whatever mental facualties they have left rotting away in isolated torture, rather than face the fact that mom/dad/uncle/aunt is dead. This is very very common.

This ethacist's position is a very visceral primitive instinctual selfish childish reaction. "X makes sense and is good/moral/logical, but my inner spoiled child wants Y for myself, so Y it is".

She would rather her invalid husband remain a prisoner in a power chair needing every basic undignified ADL activity carried out by a private nurse aide, rather than face the fact the next time the big pneumonia/sepsis scare hits, maybe they should elect for minimal intervention. She'd rather know "my husband is at home waiting for me" than deal with the frickin' reality.

She's probably used to treating him like a child she can control, given he is a manic depressive and all.

Cognitive dissonance, basically. In a word. It's very common. Her selfish behavior failing to match with her morally correct teachings isn't all that uncommon, either... and it sure as hell doesn't offer evidence that perhaps prolonging life is the "right" thing to do.

Just as sexual exploitation/pedophilia of religious leaders doesn't offer evidence that perhaps pedophilia/rape isn't all that bad, so here does this case offer no evidence in way of medical ethics debate.

Dinah said...

I didn't read it quite that harshly. I thought he believed one thing, but then faced with the reality of the situation, he changed his mind. And given that he has expressed that he has been glad to be saved in the past, it's hard to actually know what he wants.

"She's probably used to treating him like a child she can control, given he is a manic depressive and all."
That seems like quite the assumption. He's a respected, Harvard educated doctorate level college professor with many accomplishments (bipolar since adolescence). If she's used to treating him like a child she can control, perhaps it's because he's immobile and depends on a vent/wheelchair/coordination of caretakers, and not because he's bipolar?

The comparison to pedophilia was lost on me. I do believe that if this man was consistently saying "No machines, let me die" she would, the point of the article to me was that people change their minds and you don't know what it feels like to be in certain shoes until they are on your feet and you've been trekking along in them.

roblindeman said...

I dunno. I thought we owned our lives. Maybe I'm wrong

Joel Hassman, MD said...

Quality of life is an individual specific term, what defines my quality of life may not be the exact definition for the person next to me, but, we both want to gain the most and appreciate it the best possible.

Let's face it, this society/culture can't handle death, how many people have we seen as providers over the years who are still grieving a loss acutely that occurred YEARS ago? And as the nurse above said so well, "they keep loved ones alive because they'd rather someone rot in a bed and suffer stage 4 decubiti and stare at a ceiling for days on end with whatever mental facualties they have left rotting away in isolated torture, rather than face the fact that mom/dad/uncle/aunt is dead."

What the above author did not write specifically is how so many "loved ones" expect others to provide the chronic care services for this end of life expectation. And thus why health care expenses will never realistically be reeled in to be manageable and contained. People die, and death is part of life. Spending the last weeks or months in acute care settings is cruel and inhumane until proven otherwise.

And if someone takes the time and energy to make a living will, who the hell has the right to trump those wishes if the person who wrote it wants it in place ongoing?

Amazing how a story like this can inspire people to think they can live beyond what nature intends.

Interpretation and agenda can take people far, eh? Just never an infinite ride!

cady said...

I don't want to judge the wife too harshly, because I am not in her shoes. But I have to wonder if her husband would still be alive if she were dead. What I mean is that I wonder if he only stays alive for her. I don't know that he is changing his mind on death. I do think he wants to die. But if he has to take his wife into account, a woman who obviously wants him to live, then it probably does get harder for him to insist on death (leaving her for the afterlife). Ever see the movie The Hours. Ed Harris's character, dying of AIDS, tells Meryl Streep's, "I think I'm only staying alive to please you."

Anonymous said...

Dr. Hassman writes, "And if someone takes the time and energy to make a living will, who the hell has the right to trump those wishes if the person who wrote it wants it in place ongoing?"

Well said. My grandparents had one in place, and as a family we never thought to question it. It was not our right. Our job was to be there for them, honor their wishes, let them know how much they were loved, and let them go. That's exactly how I would want to be treated, too.

I see why people get DNR tattooed on their bodies. Not such a bad idea.


Dinah said...

I am going to add that my post doesn't do justice to the article. The man had advance directives not to prolong his life, but essentially, he changed his mind and he has wanted care and said he loves life. Then he wrote a final letter, asked to have the machines turned off, which they did, but he didn't die after a few minutes and asked to have them turned back on. it's not that his cruel wife is keeping him alive against his clear and expressed wishes, it's that he's changed his mind a number of times, she's been unsure what to do, when she has had him hospitalized and he's returned to a prior level of functioning, he's expressed gratitude. Read the article before you comment, it's more complex than my blog post conveys.

Sunny CA said...

I think it is all too easy, as a perfectly healthy, fit person to assume that a physically compromised life would not be worth living. There is an arrogance to that view, that handicapped or ill people have nothing to live for.

When a person experiences a life-altering physical injury, there is bound to be depression and a period of adjustment to the new reality before the patient discovers ways of coping within the new limitations, and finally the patient may realize that their previous life view of there being no life worth living alter being handicapped, was just wrong.

This is my take-away. Advanced directives often make an incorrect assessment that the life of an injured or ill person is worthless, but from the perspective of that individual that may be wrong. Look at Stephen Hawking, as an example.

If a person is brain-dead, the issue is different.

Anonymous said...

Rob and Joel, very shallow. I imagine that someone in his shoes has days they wish they were dead and then once they survive find reasons to live. What a beautiful and complicated article. Life/death is not simple. Ps. Lets not call the wife selfish, they seem to be doing a dance. I am sure caring for him is not her dream either.

roblindeman said...

Anonymous, you misunderstand. My point is that the decision as to whether to go on living belong to the liver, not to someone else (exceptions being jurisdictions in which capital punishment still exist). If that is very shallow I plead guilty as charged.

The fallacy, it seems to me, is one that is taken for granted by many at this site (including the authors, I might add): That individuals can and do free will, and in those instances others may appoint themselves to substitute their own will(s).

Now, wanna talk about shallow? How about examining THIS proposition a little more deeply than we tend to do?

roblindeman said...

[excuse me: *can and do LOSE free will*]

Anonymous said...

Rob, are we back to the tiresome argument that one should be allowed to commit suicide? We only have free will so long as we bide by society's norms. We always have free will of conscious however in how we think about things, unless of course we have a thought disorder. Thanks for challenging me to dig deep:)

roblindeman said...

"We only have free will so long as we bide by society's norms"???

You cannot be serious!

Please tell me you mean something other than what you just said!!!

[We may stipulate that you meant
" 'abide' by society's norms"?]

I hope I don't have to break this down for you. In the former Soviet Union, those who didn't abide by society's norms got thrown in the gulag. Just sayin'

Samm said...

Rob,the decision whether to go on living is something I have imagined as belonging to the heart rather than the liver. I will give you gut. I suppose liver is close enough.
I do agree with Dinah that this fellow has changed his own mind, for whatever reason, and if he chooses to live for his wife, no one has the right to deny him that sacrifice. we to tend to play the other side by telling the seriously suicidal that they should keep living for others. Granted, this man needs extremely high levels of care as Dr Hassman pointed out but if that if cost of care is the determinant of who shall live and who shall die, that is a slippery slope.

Anonymous said...

I think the word is ironic? Or facetious? Anyway, since unplugging machines involves others, just as well as keeping machines plugged in involves others I would say he lost his free agency the day he had his accident. And, I don't think we will solve the concept of Free Will on shrink rap or anywhere else.

roblindeman said...

Thank you Samm, for the creative illustration of the anatomy of the soul!

The problem is more complex than we have addressed thus far. It is simply this: Other people besides this couple are paying for his care!

The Libertarian argument is undermined in situations where others pay for your decisions. In these and other matters, we'd all get along much better with one another if we lay in the beds we made for ourselves.

Anonymous said...

1. Seems like they had insurance. Isn't this why we purchase policies? I think your a socialist not a libertarian Rob.

2. Bed they made. It was an accident.

roblindeman said...

You're confusing "insurance" with "benefit". What the family has (and what my family has, and probably most of our families have) is a benefit that pays for medical care so that you don't have to. As a result, the amount of the services delivered goes way up and no one knows what the hell it costs, but it's a lot. Insurance is something else entirely.

I simply don't understand anon's confusing me for a socialist. I thought I articulated the anti-statist position fairly clearly. What am I missing?

Anonymous said...

If I pay my insurance then I get my benefit if I need it. Atleast I will until obsmacare goes into effect and then who knows. I read it that you thought his care was too expensive and perhaps not deserving of just one life (rationing, death panel) . So I suggest socialist! Am I wrong?

roblindeman said...

Anon, it appears you don't understand concepts insurance and benefits, and this is not the place to explain them to you.

Ditto for "socialist".

There is a great deal of confusion over terms on this blog. An earlier commenter conflated "agency" with "free will". For clarity, I'd appeal to the much-maligned Wikipedia.

Anonymous said...

I'm not as educated As you but I know I pay health insurance, life ins and a disability insurance bill so that I am covered in case of terrible accident. Thanks for not giving me lecture on benefits And ins, I was a lit mAjor so I am sure I won't comprehend.

Ps your funny!!

Anonymous said...

Ps rob, free agency reference was me as in free agency of man ....don't be so superior !! ;)

roblindeman said...

Usually I don't engage in these arguments, but I can't help myself.

This isn't about superiority, this is about speaking in terms whose meaning we can all agree on!

Free agency? Are we talking philosophy or baseball? The philosophy of baseball?

Dinah said...

I have no idea what anyone's talking about.

I made some assumptions. I've never heard of a health insurance company paying for a $45K wheelchair, they've given my patients a hassle about a $5K motorized wheelchair. I assumed the couple paid for it.

I've had patients who've needed 24 hr care on a long-term basis. They pay cash for it. The other option seems to be a nursing home, also not cheap. But I did assume that the $250K was coming from the couple's savings, not from insurance or the taxpayer (the patient would have Medicare).

I believe people should spend their money as they wish.

I did assume that insurance foots the bill for the multi-week hospital admissions.

jesse said...

Sunny's comment above is most thoughtful, perceptive, and worth reading again for anyone who has not yet done so.

Anonymous said...

I am sure there is a philosophy surrounding baseball but I can't know everything! My final comment: the whole point, I believe , was that the wife held very strong beliefs about ones right to die, etc (it was her life's work) and how her change in circumstances changed her strongly held and probably stubborn beliefs. A lesson most of us here could learn from, incl me;)

cady said...

I did read the article, and I think the wife is unintentionally cruel. I don't think she is a bad person. A commenter pointed out that they are both doing their own dance. It goes both ways. I don't like that she speaks for him all the time and I feel like she guilts him into staying alive. She wantws to be in control of his life and death. He did write a Final Letter, but she disregarded it the second he got that pleural effusion. She says it is because he wanted a "generous death" where he could be coherent and have family all around. But as the writer pointed out, that's a difficult death to achieve (at least naturally). I know the husband said she did the right thing once he was coherent and stable. But I really get the feeling that he only says that stuff to her because she wants him to live so bad. Conditions were perfect for him to die. It would have been natural and in their own home. The "generous death" thing sounded like a cover for her own desire to keep him alive. That's more like a dream of how someone might die rather than a real option. The reporter notes that this guy looks like he feels guilty just for being direct to his wife and trying to get her to stop speaking for him all the time. The respiratory therapist also saw this. When he wanted to cut out the respiratory therapist, the therapist told him that she would leave if he was willing to explain it to his wife so she would understand. He got scared, backed off, and didn't cut her out. Also, when he had all the machines turned off, that was after telling the therapist and his wife that he didn't want to go to the hospital anymore and only wanted to accept treatment for things that were reversible on an outpatient basis. He fully believed he would die within minutes of his pacemaker and other stuff being turned off. When he didn't immeidiately die, he realized that he was stable and continued on so he could teach his class that afternoon. If he were unstable, and he could just immediately end it by cutting out the machines, I think he would have wanted that. There's a difference beetween dying in hours and dying in minutes.

What I thought was really telling was when the writer called the couple and asked about the Final Letter so he could ask why the wife ignored it. Right after that phone call, the husband became suicidal and wanted his machines all turned off. The writer, on his end of that conversation, was thinking that Peggy would probably not ever think that conditions were good for Brooke to die.

Direct quotes from the article:

"When she makes a mistake, I asked, do you ever correct her?

“No, because I don’t want to upset her.” His brown eyes got very big

Personally, I think he wanted the pleural effusion to kill him. He just couldn't tell his wife, after they had already saved his life, that she had made the wrong choice. He doesn't like to correct her and he's a softie where his wife is concerned. But I would want my own family members to respect and support me. Pseudo Kristen's comment was very good. It's not the place of family members to second guess and challenge that kind of thing. Love, honor, and support is what I would want. It would probably be really difficult for me to let go if I had family members like this man's wife.

Anonymous said...

I think the reason I felt so upset by this article was this part of the story where there is laughter about giving him an illusion of control:

"If for some reason Brooke had become unconscious, she and Jaycee would have revived him, Peggy told me, because she didn’t believe he really wanted to die. She thinks what he really wanted was to believe he had a measure of control, that he could ask for an end to his life and be heard. “We showed him that we would do what he asked for,” she said, “and he thought it was real.” But it wasn’t real, I said..."

It sounded like some kind of sick game. Who does that? We're going to let you squirm just until you're unconscious and then we're going to bring you back - do cpr and crack your ribs, and so forth - just so you could "feel" like you have control, even though you really didn't? Maybe it's just me, but I found that part very disturbing. Nothing remotely funny about that. All I could think of was what did he really think when he learned that. Afraid? Hopeless? I just found that part to be very upsetting.

For me it's not an issue of whether his life is worth living, that's not my call to make. That's his call.


ItsTheWooo said...

The wife sounds like a horrible human being.

I see this dynamic constantly IRL. The husband is a prisoner and he goes through the motions not only because he loves her but because they have had this dynamic since they got married. She is in control, and he follows what she tells him to do.

In an ironic way he might even be happy to be alive, as he is still able to fulfill his real goal of serving her.

Joel Hassman, MD said...

The problem from my perspective is once again people turn to the law, which is black and white per right or wrong, do or do not, and then apply it to issues that are pure gray.

A "living will" unfortunately as crafted is a black/white document, do not sustain life if it presents as unsustainable if with loss of quality of life or profound dependency needs. Yet, this is being debated now like people who agree to this can suddenly decide whether the terms have dramatically changed and can then say no today, then demand yes tomorrow, and this sine wave debate only confuses, annoys, and even possibly outrages those around who are invested and concerned with the living will's owner.

And, as I said at the onset in the thread, people can't handle death, so what is the point of a living will if you don't understand there WILL BE a moment it is likely you will die or be kept alive in misery? You have to get out of the box our society forces one into in this "live indefinitely attitude" and even more annoying, accept the concept that other people will do the work to keep you alive, and those others FREQUENTLY are not immediate family.

Amazing when you are responsible for the time, money, and energy to sustain a person, the reality to what is involved in those "costs" impact rather damn quickly, eh?!

Anonymous said...

So a wife caretakes her paralyzed husband for 12 years snd is called cruel, stick, selfish? Funny! You guys haven't taken care of anyone. Maybe. My guess is she would secretly love to unplug him, and this guilt keeps her from unplugging him. Gray for sure. Everyone, I guess, has done their best in this situation...

jesse said...

Many (not all) of the comments above show the wish to understand what the husband "really" wants and express that his wishes should be followed. Others try to understand his or his wife's motivations for their behavior. So while the above comments are quite astute, what are the principles to guide us in the situations in which we are uncertain as to the wishes of the other?

Dinah is asking how we deal with ambivalence and uncertainty: The person who changes his mind repeatedly. On which of his varied expressed wishes do we act? How can we be certain we are not acting on the wish of which we approve rather than on the actual wish and intent of the other?

The problem she seems to be addressing is the situation in which we cannot be certain. The person’s wish is not stable, or is clouded by mixed messages: the person who says "yes" while moving towards "no." or states "no" adamantly while acting out the opposite.

We would likely agree that if a person makes a will, it represents his wishes of what should be done when he is gone. If a person makes a living will the presumption is that it takes affect when the person is alive but no longer can express those wishes. But what if he has made the living will but while still alive indicates, or appears to indicate, another intent? How should that situation be handled, legally, by the family, by professionals?

cady said...

"On which of his varied expressed wishes do we act? How can we be certain we are not acting on the wish of which we approve rather than on the actual wish and intent of the other?"

Why not just act on whatever decision was not influenced by his wife. He's pretty consistent about wanting to die when his wife does not influence the choice. He didn't tell her to save his life or ask to go to the hospital during the pulmonary effusion incident. She did that on her own while he was delirious.

I would think there would be fairly easy ways to determine what he actually wants. How about send him to a psychotherapist who specializes in the dying process and have him work out what he wants (without his wife). Present the plan to the wife and have her (hopefully) agree to it. And there can't be any excuses like with the Final Letter where she said that it didn't count because it only applied in situations where he was not delirious and could die with all of his family members surrounding him. She has to follow it to a tee.

I don't know why it is so hard for him to be direct with her, correct her mistakes, or get him to stop talking for him. I don't know why she insists on talking for him and being in control all of the time. Maybe they both need some therapy. Frankly, I don't consider their behavior in the marriage to be the norm. It shouldn't be this difficult.

If they have any spiritual issues about it, they can always go to the nearest Buddhist temple cuz tha is the religion he feels closest to. They aren't hitting Nirvana with all of their flaws. I'm sure both of them will be reincarnated and maybe have another life together.

Anonymous said...

Wow! Walk a mile in their shoes. You can't imagine why this might be difficult? That's difficult to imagine. Ps psychotherapists can / may have their own bias too. Lets take the article for what it is. A touching, human tragedy.

cady said...

Yeah...I don't understand why the wife is talking for him so much (controlling him) and can't seem to stop even when asked. And I don't understand why it is so difficult for him to be more clear with her and to overcome his fear of possibly upsetting her just by being direct.He NEVER corrects her mistakes (his words). It's not normal.

I said nothing about the diffulty of what they were experiencing health wise or the caretaking aspect. Why even be married if you can't communicate with each other?

Anonymous said...

Jesse, I understand what you are saying, and I get that it is confusing when a person says yes one day and no the next. That I get. If she is really unsure what his wishes are that's one thing, but what you don't do is toy with someone. You don't pretend to let him die, even letting it get so far as the person becoming unconscious which she said she was willing to do, then plan to turn around and revive him because you think he didn't really want to die. Then, she let him know it was just a joke, we weren't really going to let you die. I think that's very cruel. The planned revival could have put him through unnecessary pain and suffering. If she had let him get to the point of being unconscious and he accidentally did die during this pretend you're-dying-exercise, what then? Would that be okay?

If she's not going to let him die, because she thinks he doesn't mean it, then she shouldn't play games with him and do the pretend we're letting you die thing. That's messed up. It wouldn't be okay for a doctor to play that game with a patient, and it's not okay for a family member to do it either.

Pseudo Kristen

Dinah said...

Jesse-- well said.

Pseudo-Kristen: I agree, it's presented as playing games.

All: remember, we're getting the story through a reporter who puts her own spin and interpretation on things (which may or may not be accurate) and even direct quotes may be taken out of context or used to mean things they don't, and part of the issue is to sensationalize because that's what the press does.

It's a difficult story, I found it hard to villify anyone. Certainly, no one wants advance directives that say they can't change their mind, and even if the wife is controlling or makes assumptions she shouldn't, she's been through a lot herself.
I thought Jesse summarized it well.

Anonymous said...

Ok shrinks, this questions for you.

"She really felt like he needed a measure of control"

You've never led your patients to believe they were in more control then they were for therapeutic reasons??

jesse said...

Yes, P-K, I agree you don't toy with someone. So if it were exactly as it is being related (as Dinah said, it's a story in the paper) you are putting your finger on one of the many subtexts that can go on in a relationship. My point was to address only the overall problems present herein regard to uncertainty, and specifically NOT to address this particular case.

Anon asked to the Shrinks You've never led your patients to believe they were in more control then they were for therapeutic reasons??" I can't recall any time I have. I have no control over my patients. I have, frequently, tried to help my patients see that they might be able to have more control in a given situation than they thought they did.

Anonymous said...

Exactly! Not that you are in control of them but that that they are in more control if themselves. How many psych patients deal w/ rx/ therapists/ probation officers/ guardian ships? Maybe his wife knew after many years of knowing him that he just needed to feel in control of his body that was stripped of all control? Well never know but it's plausible? I find p-k and others mighty judgementsl, but maybe it strikes a chord,

Anonymous said...

Ps Jesse;
If you have ever sat with a delusional patient and didnt counter those delusions then you are in fact letting them maintain that sense of control. Right or wrong.

Anonymous said...

Everyone's acting as if this is a normal married couple dealing w control issues. He lost all bodily functions and she lost a functioning husband. Stress, depression, resentment...where should we begin. She would probably like to unplug herself.....

Dárvini Aranes Fook said...


Simple Citizen said...

This article bring up the dilemma: We have the right to die, but not the right to commit suicide.

This makes my life in Consult Psychiatry extremely difficult, especially when someone has an advance Directive that states "Do-Not-Resusciate" and then they try to kill themselves.

They arrive at the hospital in critical condition, the medical team knows the need to be intubated and they are likely going to go into cardiac arrest. Should they intubate them and save them because suicide is illegal, and the person may want to live when they are not in crisis? Or do the doctor's let the patient die because of the patient's pre-written wishes?

Worse yet - what if the person didn't have an advance dir3ective, but when they are crashing in the hospital, they tell the whole medical team that they refuse CPR and intubation. Does a person who just attempted suicide have the capacity to make that decision?

More of my thoughts here if you're interested:

Anonymous said...

Suicidal psychiatric patients are often asked to sign informed consent documents to agree to treatment, so I don't see why they can't also sign an advance directive. If they have capacity to sign an informed consent (or agree verbally) to treatment, then it follows that they have the capacity to refuse treatment (including CPR).

It's chilling to think that a DNR might be ignored simply because I'm a psych patient. What I would want in a situation where cpr would be required is a separate issue from a suicide attempt. Regardless of how I ended up in a situation where cpr was needed to try and save me, I would have no desire to spend the rest of my life in a nursing home unable to care for myself. So, I believe the DNR should stand.

Pseudo Kristen

jcat said...

The whole article gave me a really bad taste in my mouth. Everything that is mentioned in the article of his life prior to the accident shows a man who pretty much did things his way. And escaped from home whenever he could.

Now he's completely dependant physically, and almost as dependant mentally. Because no matter what he says, the wife will decide on it's validity. She will talk for (or over) him, she will interpret what he says, she will decide what he means. She will decide when or how he can die, and until then she'll override his wishes, no matter how clearly they are expressed.

And that really sick game she played with unplugging the machines, knowing that he wouldn't die in the short-term, but saying that if he even got as far as losing consciousness, she would have intervened anyway? SHE didn't think he really wanted to die, SHE thinks he just wanted too feel in control....

And at the same time get to play the martyr, over having to keep working, over depleting their savings for the care he needs.

Agreed, we don't know the complexities of their relationship before the accident, but from the article it seems that everything now is about control. And she has it all.

I wouldn't want her teaching me about the ethics of end of life.

Anonymous said...

The Salt Lake Tribune reports that Professor Hopkins died yesterday, "surrounded by family and friends." I hope it was the "good death" that he wanted for himself.

Anonymous said...

Here's an article from yesterday's Salt Lake Tribune on Professor Hopkin's last days:

It does seem he got the "good death" that he had hoped for.