ROBERT WENDLAND’S NON-SUICIDAL INTENTION

In a fairly substantial piece I am writing on Robert Wendland I state that the Amici Curiae brief submitted to the California Supreme Court supporting his extubation was badly written due to its adversarial legal setting and poorly informed by traditional Catholic medical ethics in spite of several “Catholic” institutional undersigners. My review of the Court's decision notes that it saw this case as a request to kill a conscious  patient who was not even sick, who was making limited progress, and who would be likely to suffer distress, since he was conscious, from the prolonged process of dehydration. I suggest further that the Court may very well been aware that claiming that such an action was a legitimate "letting die" of a dying patient would sound like nonsense to objective observers. And worse than nonsense, it would be open to the kind of plea that James Rachels makes that active killing would be more merciful. (Rachels' piece has been reprinted in most college texts on this issue.) 
        My judgment of the case, as framed by the Court's language, is obviously negative about the Amici Curiae brief and completely in agreement with the Court.

There is, however, a question left unanswered:  If Robert Wendland had been less cognitively disabled would he have been suicidal if he asked to have all the technology removed? My answer is that in judging his own case he can choose any probable opinion and the following I take to be a probable non-suicidal application of the principle of double -effect to his case: Robert Wendland could say to himself: "I was severely injured in my accident and the medical interventions imposed on me while I was unconscious had a good purpose--to provide time to see if I would recover. They arrested a dying process and removed the danger of dying inherent in my inability to eat while unconscious. Now that I am conscious it appears to me that these technologies cannot aid my recovery. I remain in a state of "arrested dying" where the life I have is essentially an artifact of technology, a human creation, which could be called a "fabricated life." Its fabrication does not make it a bad life, but it does make it a continual production of human skill. It is a basic moral principle that we are responsible for what we create by our technology and have not only the right but the obligation to judge its balance of benefits and harms. In this case the judgment is whether the harm prevented by the group of medical technologies(my death) is greater than the unintended but obvious and unavoidable  harm of its side effects. The side effects are the unnatural and unbearable conditions which these technologies impose on me. These conditions outweigh the harm of losing the fabricated life the technologies are meant to provide. The conditions are worse than the death which will occur when I decline the technologies. In declining them I am not seeking or intending my death. The vulnerability to death which will occur upon their removal is due to the original trauma (the "underlying cause of dying") which I did not intend, and which I would reverse if I could do so without such serious harm to my person--the serious harm of the conditions the technologies impose on me. I merely accept that death and reject the technologies since they do me no good in the balance."
        My comment on this reasoning is that it contains two applications of the principle of double-effect. One in which the deliberate action being judged is the imposition of the medical technologies for the sake of providing a fabricated life (which is different from healing), and in the second the deliberate action is the decision to order removed from oneself the medical technologies for the sake of being rid of their excessive pain, distress and mental costs. Robert could reasonably go on to say: "That a side effect of this action will be that I will lose the fabricated life is something that I accept. I am not acting in rebellion against God or nature since neither God nor nature is the author of this fabricated life and certainly not of the excessive pain, distress and mental suffering it brings with it. It was something invented by medical science and for me it has no good purpose. So I reject it."
        Our normal abhorrence of "quality of life" considerations in judging life-preserving technologies is based on a distinctly Judeo-Christian conviction of the sacredness of life, even when seriously reduced by disease or trauma, such as we see in the victims of serious stroke. But in those cases we need to decide whether the low quality of life is simply an abiding injury while the body itself, with some help, carries out the normal self-therapeutic functions of nutrition, metabolism, respiration, fighting off infection and so forth. As each of these is replaced by a technological intervention we approach admitting that the life is a fabrication, not the sacred gift of God, but the product of human technology and therefore open to judgment. There is no moral slippery slope in this argument, but only the vagueness of the distinction between a natural, but diminished and self-sustaining life, and a fabricated life. Indeed, if we do not allow and actually require this kind of judgment on "fabricated life" we run the risk of another slippery slope, namely a slide into the claim that biological life is to be maintained at any and all costs including Frankensteinian impositions on hapless patients.
        It is fortunate that the legal right to refuse medical intervention preserves competent patients' right to select any probable opinion about the moral rightness of their rejection of medical interventions.  But the Court made clear that what it was refusing to accept was not any of the careful distinctions about non-suicidal or non-killing intentions at all. It was refusing to accept the intentional killing of a patient who was not dying. My representation of Robert's probable opinion was that he judges his state to be one of unsuccessful (due to unacceptable side effects) arrested dying, and that his decision is to reject the unsuccessful technologies, not to kill himself.
        Finally, it is interesting that the Court, probably innocent of any knowledge of the distinctions of "probablism" (to which Robert is entitled) and "tutiorism" (to which third parties are obliged) concluded by explicitly using  a "safer-course" reasoning to impose a "safest course" standard of proof.