A codicil to my living will.

• Author: Huber, Richard M.

Decision about the termination or prolongation of life should be made by the dying patient, not by physicians.

DEAR CHILDREN:

Of the Ten Commandments, only the fifth promises a reward -" Honor thy father and thy mother: that thy days may be long upon the land which the Lord thy God given thee." The honor that you shall do me is obedience to the following instructions.

Should I become terminally ill or permanently unconscious, I do not wish to be given any means of life support. Certainly, machines that can breath for me, pump my blood, and feed my faltering frame are a blessing when there s a reasonable expectation that I will be my "old self again." When the "new self" is a body comatose and a mind deadened with no expectation of recovery, though, the miracles of modern medicine become tragedies of unreasoning intent.

When my higher brain no longer is functioning, you should pronounce me dead. At any give time, 10-25,000 adults are abondoned to a persistent vegetative state. They join 4-10,000 children who also are wretched survivors in a comatose state. Their brain stems are working, but there is no conscious thought, no sensation. Imprisoned in a living death is not for me. Our higher brain is what makes us human. To exist without it is to be inhuman.

If an objective of life is to control the living of it for whatever ends we shall choose, why shouldn't an objective of dying be to control the manner of its arrival? What we must fear is not so much suffering, which can be softened by medication, but loss of control. Desperate medical personnel pounding on my chest, tubes inserted into orifices designed for other purpose, friends wondering whether maybe it wouldn't be "all for the best" to let me die - that's a death of aesthetic vulgarity and existential absurdity.

Death is a part of living. Death is not an event outside of life, but takes place within it. True, death does do something to life. It ends it. However, it does not end life outside of life, but within it. Thus, we should act to control death with the same intelligence with which we seek to control life.

I do not want physician to make decisions about my dying. Doctors should keep people alive. It is not really fair to ask a physician trained to prolong life to make the decision to end it. That is like asking a businessman to lose money. A doctor's job is to explain the medical options and consequences. Choosing to call life-saving measures "heroic" rather than "extreme" is a perfectly appropriate fantasy for physicians to treasure. Yet, they should not muddle their minds, trained in the natural sciences, with existential matters propery belonging to the humanities (what's best for me and for society) and the social sciences (what the cost in money is going to be.)

Physicians in attendance to the dying confront two alternative. Fees are accumulated as the life of the dying patient is prolonged and cease when his or her life end. Since few people prefer less money than more, a conflict of interest is inevitable.

Conflicts of interest, whether with politicians or physicians, are troublesome because the interest sacrificed too often is not that of the politicians, but the public; not the physicians, bu the patient, So, decisions about the termination or prolongation of life should not be made by doctors any more than time spent in office before the next election should be set by politicians.

Since your fidelity to my wishes may collide with the physicians' obedience to both professional principles and human cupidity, think of their role as automobile mechanics. The latter look...