Just as the case of Nancy Cruzan introduced millions of Americans to the legal realities of exercising the right to refuse medical treatment, perhaps the case of 87-year-old Helga Wanglie will prove instructive in another way.
Since last May, when her breathing stopped and she suffered irreversible brain damage, Mrs. Wanglie has been in a persistent vegetative state, receiving acute care at the Hennepin County Medical Center in Minneapolis. She cannot breathe or eat on her own.
Soon after her condition became clear, the medical staff, with the approval of the hospital's ethics committee, came to an agreement that further treatment was inappropriate and not in her best interests.
Her husband disagreed.
The standoff continued until January, when the hospital decided to take the matter to court -- the first time, apparently, that a medical institution has taken such a step against the wishes of the family.
As I see it, this case comes down to one basic truth: Human beings are mortal. However much we want to delay or deny it, we simply cannot avoid the inevitability of death.
Oliver Wanglie, a retired Minneapolis lawyer, says that his wife told him she wanted everything done to keep her alive if she ever ended up in this condition. He cites his wife's strong religious beliefs that only God can decide when she should die, and accuses the hospital of trying to play God by ending his wife's life.
The hospital sees it differently.
Physicians, nurses, administrators and the institution's ethics committee all agree that continuing to force life into Mrs. Wanglie's frail and failing body is simply inappropriate medical care. Her biological systems cannot be repaired, and the extraordinary means that are needed to keep her breathing and "alive" are not in her best interests. Her body should be allowed to finish the dying process.
The case made headlines, of course. It poses an intriguing counterpoint to the Cruzan story: If families, acting on behalf of incompetent patients, have the right to refuse life-prolonging treatment, do they also have the right to demand that any treatment, however extraordinary, be used to keep a person alive?
But the two cases aren't quite a perfect parallel. Medical decisions about discontinuing life-sustaining treatment must always be made in context; on the most basic level, they must take into account the goals of medical treatment.
The American College of Physicians has published an ethics manual that neatly summarizes the basic goals of health care: to promote health, to relieve suffering and to prevent an untimely death. However much her family wishes to deny them, the facts in this case indicate that the time for Helga Wanglie's death has come. To deny that reality is, in effect, to attempt to "play God."
Dr. Lawrence P. Ulrich, a bioethicist at the University of Dayton in Ohio, notes that this case points out the fact that our society doesn't think about the process of dying seriously enough. We shy away from the realities we face. Physicians "don't use the words death or dying enough in talking with families," he says.
And so, in too many cases, families put too much faith in medical technology and are unprepared to accept its limits.
Speaking of faith, here's an eternal riddle: Why is it that the people who most ardently claim a strong belief in an afterlife are often those most anxious to postpone it?
Send your comments and questions about death and dying to Sara Engram, Mortal Matters, The Evening Sun, P.O. Box 1377, Baltimore, Md. 21278.