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Letter to the Editor   |    
End-of-Life Questions
EDMUND F. KAL, M.D.
Am J Psychiatry 2001;158:1742-a-1743. doi:10.1176/appi.ajp.158.10.1742-a

To the Editor: The essay by Barry R. Berkey, M.D. (1), was both thought-provoking and heartrending. The author feels that we show more compassion and more respect for the dignity of a dumb animal (yes, famous, cuddly, and beloved but still only an animal) than for that of human beings—in this case for Floyd, the author’s brother—in allowing him to live for 6 years in what seems to be essentially a decerebrate condition. And all this—the author does not spell it out, but it seems obvious—quite paradoxically precisely out of alleged respect for Floyd’s humanity.

But wait a minute! How can, in the circumstances described, anybody—even the most compassionate and loving brother—know with true certainty what Floyd would have wanted? A panda, no matter how seemingly intelligent, cannot tell us and cannot think, even in the best of circumstances, at least not as humans do. So we feel authorized, even obliged, to make life-and-death decisions for it (especially after we have already decided, presumably without its informed consent, to remove it from its native habitat and hold it in lifelong confinement for the amusement and maudlin sentimentality of us humans). But Floyd was not a panda, and that, precisely, is the difference. Only with the greatest hubris could any of us presume to know with moral certainty what he would have wished—except, perhaps, that he wanted physical comfort and tangible signs of loving care, both of which, in fact, he received in abundant—nay, superabundant—measure. By what (mis)interpretation of love or dignity would we want to deprive him of that?

The moment comes (and 6 years is a long time) when we must admit, no matter how reluctantly, that we have reached the end of our financial and emotional endurance, that any further efforts to keep Floyd alive assertively would interfere with other duties, more or at least equally important, vis-à-vis others or ourselves. Even the Judeo-Christian Bible (and, I reckon, the Buddha and the authors of the Qur’an and Vedanta Veda would agree) bids us to love our neighbor as, but not necessarily more, than ourselves. But even then there is a world of difference between ceasing all action to sustain life, providing mere freedom from pain and discomfort and letting nature take its course to a natural death, and actively intervening specifically to end life itself. Furthermore, it is one thing to do this because we admit honestly in our consciences that we cannot afford to do more and totally another thing to arrogate to ourselves—whether a doctor, family member, or the highest court in the land—the ability or right to divine what the patient would have wanted to have done or to decide what is in the patient’s best interest.

I cannot read the mind of Floyd nor anyone else in a similar condition. I know for certain that I, for one, would vehemently object to any legislation or directive authorizing anyone to directly end my life, even if the person had to conclude that he or she could not ethically afford to do more than keep me free of pain while nature took its course.

Berkey BR: He should have been a panda (introspection). Am J Psychiatry  2000; 157:1941-1942
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References

Berkey BR: He should have been a panda (introspection). Am J Psychiatry  2000; 157:1941-1942
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