LETTERS to the editor.


Extreme Public Policy

Paul Kahn, in "Extreme Measures" (July/ August 2001), sensitively examines the delicate question of how to deal with patients in a persistent vegetative state. However, I believe he disposes too casually of a key public policy issue regarding the impact on society of maintaining such patients indefinitely. Noting that society has paid "millions of dollars ... through Medicare and Medicaid" for the care of Annie's son, Benjamin, Kahn wonders rhetorically whether this large amount of money might be better directed toward solving health problems that we would all view as extremely worthwhile. However, he then lightly dismisses this consideration by asserting that "the brutal logic of such an equation would lead to the elimination of most elderly, sick, and disabled people."

This is sophistry, disposing in a single, casual sentence what is arguably the most critical issue in his entire article. Of course, anyone with an ounce of sympathy would wish Annie to be able to see her son alive and responsive, a functioning person once again. But Kahn argues that, because of Annie's passion and courage, Benjamin, who has displayed no sign of awareness for sixteen years, who is technically alive yet not able to function in any meaningful way--just barely existing in a vegetative state--should continue in this pitiful condition for an indefinite number of additional years at public expense. Such an argument sacrifices reason to emotion.

In describing the frightful personal dilemma here, Kahn notes that Benjamin's father, Tom, no longer can perceive this "figure on the hospital bed," kept alive only by a feeding tube, as his son. But, of course, at the personal level, Annie is as much entitled to consider Benjamin alive as her husband is to consider him virtually dead.

The issue here, however, is not strictly a personal one but, fundamentally, a societal one. I don't believe society should deploy endless resources to keep "alive" indefinitely one whose higher brain functions--those functions that endow us humans with our personhood and our humanity --have not cognitively worked for sixteen years and will never do so again. It is unreasonably glib for Kahn to dismiss this issue by suggesting that such a policy would lead us inevitably to the "elimination" (by inference, to the active killing) "of most elderly, sick, and disabled people." What tortured logic, to say that removing a persistently vegetative patient's feeding tube and...

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