The Oath?

The Hippocratic Oath states: "First, Do No Harm." Medical science and Doctors have done, throughout the course of history, as much as possible to keep the patients they have as comfortable as humanly possible.

This line of reason, however, is a very delicate one. Doctors, with the goal of preserving life in mind, periodically have to cause a patient temporary discomfort in order to keep them alive. In modern world, most people are willing to accept the pin-prick of a Polio innoculation in order to not suffer from an awful disease. But the line between maintaining that understanding can grow extremely blurry when it comes to the legal and ethical Rights of patients, as well as a Doctor's responsibility to keep a person alive. Where does it begins to cross into the territory of breaking the "No Harm" rule of the Hippocratic Oath?

The concept of Medical Ethics, like any other method of thought, has it's limits. Not every situation that a medical practitioner will encounter will be easy to confine into a "black or white" framework. Modern medicine has made massive advancements in the past 100 years. While fictional accounts such as Dalton Trumbo's Johnny Got His Gun illustrate what was medically possible (if not very unlikely) at the start of the 20th Century, the story is more of a war protest than it was a novel regarding medicine. It does, however, raise a question regarding the role of morality in medicine and raises the question, arguably one of the first, of Quality of Life and going with a patient's desires for treatment. The story is that of a young soldier in World War I who is near-fatally wounded by artillery fire. He is a quadruple amputee and his face is badly mauled; he has blind, deaf, cannot smell, and is permenantly mute (essentially missing his entire face) yet still fully conscious. The doctor's responsible for the novel's protaganist refuse to euthanize him, leaving him a prisoner inside his own ruined form.

So what becomes of those individuals to whom life is as cruel (or more so) than the stroke of an author's pen? Of the many millions of possible examples where the lines might blur, two very different cases can give us an insight into the nebulous world of where "Right vs. Wrong" meet "Living vs. Dying."

The stories of Stephanie Keene, better known as "Baby K: and Dax Cowart, bring sharply into focus how modern medicine, with it's seemingly never-ending resourcefulness in saving life, falls into a trap: What is Right or Wrong, and what is Living?

Stephanie Keene was born in Virginia in 1992, to be did not have a true chance at life. In utero, she was afflicted with a condition known as anencephaley - somewhere in her development, she developed only a brain stem but no other portion of her brain. She would be, throughout her life, a vegetable, capable only of the functions of the autonomic nervous system such as breathing, heart-beat, and the ability to detect touch. She would never have had a conscious thought. Despite being notified this development prior to birth, her mother would not terminate the pregnancy due to religious conviction. Doctors also advised her, after being born, that she would not gain consciousness and suggested that the child be taken off of life support so that "nature can take it's course." After being weened off of life ventiation, the child did not thrive and had to be taken into hospitalization several times to be kept alive. A court battle ensued; the hospital and state wanted to take power of attorney from the patents, and the mother argued in court that her spiritual convictions that "all life is sacred" kept her from being willing to let the child die.

Baby K eventually passed away six months after birth without ever having a single conscious thought.

Dax Cowart, on the other hand, had lived a normal and healthy life. While assisting his family with menial tasks, he was badly burnt when a gas leak nearly took his life. The resultant fire left near-terminally injured; prior to being subjected to life-saving techniques, he begged repeatedly to be allowed to die. Left blind, deaf, and bereft of his hands, Cowart pleaded with doctors to not subject him to a treatment that could preserve his life due to the massive skin damage (nearly 70% of his skin was burnt away,) one of which was repeated bathes in water and chlorine. While this undoubtedly kept him alive, Cowart would claim that he felt as if he was "being skinned" and that he would scream with such intensity that he would pass out during each treatment due to the pain.

Dax Cowart is still alive today, living as a successful lawyer, but has said in repeated interviews that despite his present life and success that we would still have preferred to have died rather than be treated. He begged his care-takers constantly to let him die, but the state of Texas legally would not allow this, and doctors would thwart his multiple suicide attempts.

With these stories in mind, what is living? Do doctors have the right to dictate to a man such as Dax Cowart, who was clearly suffering, that living in agony is better than dying? What about Stephanie Keene? Was she ever alive to suffer? While it is impossible to argue the rights of a parent to protect a child, was she truly in her "right mind," able to make choices that were in her best interest, let alone that of a child?

I will leave it to the reader to make those choices for themselves. But the question of "What is Life?" is a fundamental of philosophy, and the world of science and medicine are not immune or exempt from these things.