All Life Has Quality

Earlier this year, a Texas man named George Pickering II was in jail, charged with two counts of aggravated assault with a deadly weapon. Eventually, one charge was dismissed and the other lessened. Mr. Pickering was given credit for the time he served in jail and was recently released.

There’s a reason for the leniency shown him: He was trying to save his son’s life. And in his actions and their aftermath lies a lesson for all Americans.

In January, Mr. Pickering, armed with a gun, marched into Houston’s Tomball Regional Medical Center and became locked in an hours-long standoff with police. His son and namesake, George Pickering III, was on life support in the critical care unit. According to the father, his son had suffered a massive stroke and “They were saying he was brain-dead, he was a vegetable.”

On the decision of Mr. Pickering II’s ex-wife and other son, the hospital ordered a “terminal wean,” a process that slowly removes life support, and notified an organ donation organization that the patient was an organ donor.

“They were moving too fast,” the father later explained. “The hospital, the nurses, the doctors.”

That does indeed seem to have been the case, since, on his arrest, the elder Mr. Pickering insisted that during the standoff, he felt his son’s hand squeezing his own. And the younger man eventually recovered, it seems fully. The specific diagnosis that was communicated to his relatives isn’t known. The hospital, citing privacy laws, refused to divulge that information.

If it was indeed “brain-dead,” it was likely a mistake. If it was “vegetative state,” it may have been accurate. But in either event, the story holds considerable pertinence to the societal discussion about defining death and “end of life” care.

Back in 2006, neuroscientist Dr. Adrian Owen of Cambridge, analyzing the electrical brain activity of a young woman in a vegetative state five months after a car accident, found that, at least in her mind, the patient was able to follow complex commands. She couldn’t move, but, her brain waves showed, could imagine playing tennis and walking through the rooms of her home. Dr. Owen found similarly remarkable results in at least three other patients.

No one knows what degree of consciousness persists in a body unable to move. But now we know that some degree can persist in some such bodies, belonging to people many would previously have thought of as something less than people.

There is, moreover, also a “minimally conscious state” (MCS), estimated to be 10 times as prevalent as the more recognized vegetative one. In November, 2008, Dr. Steven Laureys, a neurologist at the University of Liège in Belgium, demonstrated that some low-level MCS patients were able to follow basic instructions — counting familiar and unfamiliar names played randomly into headphones.

All that should be sufficient to give pause to would-be plug-pullers. But a variety of factors — including the shortage of organs for transplantation — is pushing some physicians to call a life a life, even if it hasn’t yet been fully lived.

Even actual “brain death” — complete and seemingly irreversible loss of brain function — is a controversial term. It is defined inconsistently both legally and among medical facilities and personnel. And it is not, according to major poskim, equivalent to death.

The medical and legal professions are not concerned, of course, with halachah. They define death as they choose, and “quality of life” is an important factor in their calculi.

What they don’t consider, however, is that people in extremis often find themselves facing the question of life’s meaning. Not all human beings experience epiphanies, but all have the potential to be so blessed. And many, even if immobile, in pain and without hope of recovery, might still grapple with important matters — matters like repentance, forgiveness, acceptance, commitment, — perhaps the most momentous matters any human being can ever consider over the course of life. Cutting such vital engagements is a tragedy.

Life is precious, even when its “quality” seems severely diminished.

For observant Jews, that truth should be impetus for creating a “Halachic Living Will,” like that offered free of charge by Agudath Israel of America. It should also push all Americans to put pressure on legislators, hospitals and medical professionals to question their own definitions of “meaningful life.”