- Before He Wakes
Professor C, 85, is a retired English professor. He never married and now has few interests besides classical music and his beloved cat, Tosca. He has a friend in the English Department, Professor E, who visits at least once a week to make sure that he and Tosca are all right. He also has a brother, B, who lives in a nearby town, but he usually sees him only once a year, at Christmas.
In early May, Professor C has a heart attack and is admitted to the hospital, where Professor E joins him. The cardiologist, Dr. H, recommends a cardiac catheterization, a diagnostic surgical procedure that permits the physician to see exactly which blood vessels are blocked. Professor C agrees but worries about Tosca. He tells Professor E, "You'll think I'm a foolish old man, but you don't know how much that cat means to me. If I'm dying, don't let me die here. All I want is to go home and be with Tosca." During the catheterization, Professor C suffers another, more massive heart attack. The surgical team stops the procedure and, with Professor C's consent, performs a double bypass. He is then admitted to the Cardiac Intensive Care Unit (CICU) to recover.
Several years previously, Professor C signed a standardized form giving his brother durable power of attorney for his health care. The form says B is "to make care, custody, and medical treatment decisions for me in the event I become unable to participate in medical treatment decisions." It also directs that "my life not be prolonged by lifesaving measures if my condition is determined to be terminal and incurable or if I am diagnosed as being in a persistent vegetative state."
By mid-May Professor C's heart still performs well below its normal function. He drifts in and out of consciousness due to drugs he is taking. His condition puts great stress on his kidneys, which also begin to fail. Then, in the third week of May, just as his kidneys start responding to treatment, his lungs succumb to pneumonia. On June 1 he has serious difficulty breathing and is put on a respirator for a 72-hour period to be stabilized. At the end of that time he fails a lung function test.
On June 4 Professor E decides Professor C should be taken off the respirator and allowed to die. B is willing, and together they approach Dr. H. Dr. H disagrees, pointing out that Professor C isn't dying. His kidneys are doing much better—in fact, his urine output is back to normal. The pneumonia is clearing up, too, so there is no question of multiple organ failure. Besides, Professor C did consent to bypass surgery, which is a lifesaving measure, so he might want other lifesaving measures as well. Dr. H proposes a tracheotomy so that the breathing tube will be more comfortable and suggests inserting a PEG tube. He would also like to eliminate the drugs that keep Professor C in a stupor so that he can be awakened and asked what he would like the treatment team to do.
Professor E worries that if Professor C wakes up, he might consent to treatment because he is so sick, and that he would then improve just enough to have to end his days in a nursing home, unable to care for Tosca. To spare him that, Professor E wants to let him to die now, before he gets better.
What should be done for Professor C?
As Professor E is Professor C's friend and the estranged B is willing to go along with what she decides, we need not let the fact that she has no legal standing as his proxy worry us unduly. What might worry us, though, is that it looks as if Professor E would rather let Professor C die than allow him to make what she regards as the wrong decision. By all that's bioethically orthodox, hers is the height of presumption. How does she know what Professor C would have chosen for himself? Who is she to take...