COVID-19 and Passive Euthanasia
This past December, I lost my mother. She was 72.
While vacationing for the holidays, she fell and hit her head. What might have been a minor knock for someone far younger resulted in a subdural hematoma – bleeding from the brain leading to a pooling of blood – owing to her age and history with stroke. She was taken to a nearby hospital, anesthetized, intubated, and placed on a ventilator. Doctors performed emergency surgery to relieve pressure on her brain. The surgery was technically successful – the bleeding stopped and the pressure abated – but my mom was unresponsive.
This was the state in which I found her when my brother and I finally arrived to be by her side in the hospital. A situation unfamiliar to us as it would be to most people, it was doubly-so for my mom, who was strong and outspoken throughout her life and career as a college proessor. Breathing with a ventilator but not sedated, she should have been awake, but the trauma that wracked her brain had apparently caused her cognitive processes to go dark. Talking to her with raised voices yielded no response. Only the most painful and annoying stimuli, a hard pinch from the doctor or prick with a needle, would prompt her eyes to open, only fleetingly. We took those treasured opportunities to tell her how much we loved her and wanted her back with us. During the interminable hours, our eyes were glued to the various medical monitors, riding the ups and downs of her blood pressure and body temperature as she battled a post-surgery fever.
Unfortunately, each day in the hospital, she faded a little more. The brief gazes and slight movements grew harder to rouse. She was slipping away. My father, brother, and I were bluntly yet kindly given the prognosis and our options: Our mom may wake up again, but more than likely she won't. If she did, she would probably be completely care-dependent, unable to feed, move, or clean herself. The ventilator and feeding tube that were keeping her alive could do so indefinitely. The longer she was on them, her brain could stabilize and she might be able to live without them, but this "recovery" could leave her locked in, aware of the world around her yet unable to interact with it in any meaningful way. We all agreed this prospect would be torturous for her, but the alternative option: removing her ventilator and feeding tubes, felt like giving up. The doctors framed it in a different way: rather than forcing her to stay alive, withdrawing life support would allow her to choose her fate. After some consideration, we decided that's what she would want.
It turned out my mom could breathe without the ventilator, an auspicious sign, but she was still completely unresponsive. Sadly, with each passing day, her breathing grew more labored. A compassionate palliative care nurse visited frequently to prepare us for what was growing increasingly apparent: my mom was going to die. On December 27th, seven days after her fall, she passed away.
I share this story now because with many thousands of COVID-19 patients intubated and ventilated, the jarring memories and pain of seeing my mom's breathing controlled by a machine have been resurfacing. While mechanical ventilation is occasionally necessary, it is not pleasant for those who see it or endure it. My thoughts are with all those severely stricken by this infectious disease and their loved ones.
Additionally, many of these bereaved friends and family likely have faced the similar, nauseating decision that my father, brother, and I confronted: to continue with care intended to prolong life at the brink, or to allow a sickened person the option to die. Currently, between 25 and 90 percent of COVID-19 patients placed on ventilators pass away. Some patients suffer brain death. More slip into comas. The dreadful choice is worsened now as family members often aren't even afforded the ability to see their ventilated companions lest they risk infection.
Sometimes, doctors have even been forced to make these life or death decisions behind the scenes, as the numbers of COVID-19 patients requiring ventilators outstripped hospitals' abilities to provide them.
There's been a quiet debate for decades: does removing a ventilator or feeding tubes near the end of a patient's life constitute what's termed "passive euthanasia," defined as withholding or withdrawing treatment necessary for maintaining life? Some medical professionals and ethicists say yes, others no. Regardless, it seems to be the norm. Leaving more than 400,000 dead to date, COVID-19 is undoubtedly making this practice even more common, especially considering that more than a third of the dead in the U.S. are residents of nursing facilities, many of whom may have "do not resuscitate" (DNR) orders, meaning the attending doctor is not required to resuscitate a patient if their heart stops.
Speaking from experience, I know that painful, end-of-life decisions impact far more people than just those whose deaths are tallied. A lot of people around the world are going to need the collective support of caring companions and societies.