the first artificial heart
John Jobes vividly remembers the day in 1971 when he first met his future
wife Nancy. Both were high school students in Parsipanny, N. J. "She was a
very independent, headstrong, loving person," he recalls. They married a few
years after graduation, when John was working as a machinist and Nancy as a
05 lab technician. Then six years ago, while she was pregnant with their first
child, Nancy was injured in a traffic accident; several bones were broken, and
the baby was lost. "She was a real tiger and fighter," John recalls, but her
struggle to recover ended abruptly during surgery to remove the fetus. Oxygen
was inadvertently cut off, causing irreversible brain damage. Nancy Jobes has
10 been in a coma ever since, sustained by a feeding tube in a New Jersey
nursing home. John, together with Nancy's parents and siblings, wants to
have the feeding tube removed, but faces a battery of legal and medical
obstacles. "There is no quality of life," he insists. "Nancy would not want to
be in this state."
15 There are about 10,000 other Americans in Nancy Jobes' predicament, a
hopeless twilight known to doctors as a "permanent vegetative state". For
their families, they are a constant source of anguish, and there is a
tremendous financial burden. These patients pose a knotty ethical dilemma
for doctors as well -
20 obligation to relieve suffering. With few professional guidelines to help them
resolve the conflict, doctors have frequently decided to continue treatment
because of their moral qualms or fear of legal consequences.
Now a bold new ruling by the American Medical Association's Council
on Ethical and Judicial Affairs ought to make it easier for doctors to go along
25 with a family's request to end treatment. After two years of deliberation, the
seven member panel affirmed that patients' wishes, as best as can be
determined, should be respected and their "dignity" maintained. It is not
"unethical", said the council, for doctors to discontinue all life support for
patients who are in irreversible comas.
30 The council's decision reflects a growing concern in the medical
community and society at large that death in America is too often controlled
by machines rather than nature. In a sharp departure from the past, when most
Americans died at home, an estimated 80 % now die in hospitals or nursing
homes, often surrounded by a thicket of tubes and life-
35 Public opinion surveys suggest that most Americans fear and oppose this invasion
of one of life's most private moments. Last year a Louis Harris poll of 1,254 adults
found that 85 % thought a terminally ill patient "ought to be able to tell his doctor
to let him die"; 82 % supported the idea of withdrawing feeding tubes, if that was
the patient's wish. [...]
40 The A.M.A.* decision was hailed by many advocacy groups last week as
an important step in preserving the right to die with dignity. After "a period
when technology was used indiscriminately, this returns us to common-
medicine," declared A. J. Levinson, executive director of Concern for Dying
in New York City. But there were bitter objections as well. [...]
45 Some raised concerns about the so-
euthanasia. Said Dr. Mark Siegler, director of the Center of Clinical Medical
Ethics at the University of Chicago: "We start off with dispatching the
terminally ill and the hopelessly comatose, and then perhaps our guidelines
might be extended to the severely senile, the very old and decrepit and maybe
50 even young, profoundly retarded children". Adding to such worries is the
current era of medical cost cutting. "That's what this is all about, to get rid of
people who are a burden to their families and the state," warned St. Louis
Pediatrician Anne Bannon, president of Doctors for Life.
With debate still vibrant, the practical impact of the A.M.A. decision is
55 likely to be mixed. Doctors will no doubt feel more comfortable about acting
quietly with family approval to hasten the dying process. The family of a
patient like Nancy Jobes, whose plight is more public, will be able to make a
stronger argument but may still face a legal battle. However helpful, the
A.M.A.'s new ruling cannot ease the heartbreak for families weighing such a
60 decision. It is one thing to shut off a machine that is forcing the breath of life
into inert lungs. It is emotionally far harder to withdraw the staff of life, even
if it is dripping through a tube. [...]
from: TIME, March 31, 1986, p. 33
* A.M.A.: American Medical Association
Read all the questions first, then answer them in the given order. Use your own words as far as is appropriate.
1.1. Explain why the writer calls Nancy Jobes' situation "a hopeless twilight".
1.2. What dilemma do doctors face in cases like Nancy Jobes' ?
1.3. Summarize the arguments for and against switching off life-
1.4. What, according to the text, will the effects of the A.M.A.'s ruling be?
2. Analysis and discussion
2.1. Find a suitable heading for the given text.
2.2. Does the writer of the article believe that the A.M.A.'s decision is a satisfactory answer to the problem? Give evidence from the text.
2.3. Modern medicine has increased the average life expectancy. Discuss some of the problems that might arise from this fact. Write about 120 to 150 words.
2.4. What is your opinion about the interference of medicine with the natural course of human life? Write a statement not longer than 100 words.
2.5. How close to us is Huxley's utopia as presented in "Brave New World"?