Dr. Grattan Brown, S.T.D.
In the sad story of Casey Kasem’s final days, Judge Daniel Murphy was right to require doctors to feed Kasem and right to reverse that decision a few days later.
I remember Casey Kasem’s voice so well. Just that memory made it sad to imagine the suffering he endured. He suffered from dementia, from the inability to speak, and from all that goes with being bedridden. Because his particular condition, Lewy body dementia, is difficult to diagnose, he likely suffered from not really knowing what he had.
He also suffered from his family members fighting over him and from having been “stolen” by his wife and hidden from his children and friends during his final weeks of life. Finally, he was the subject of court battles, including one in which the judge had to assign different visitation times to his wife and to his children. In the end, he suffered from a judge’s having to decide between his children’s demand to remove his feeding tube so that he would die and his wife’s demand to continue feeding him so that he would continue to live
At first, Judge Murphy ordered that feeding be continued. Then within 48 hours, Judge Murphy reversed his decision and ruled that feeding could be discontinued. From media reports, we do not know exactly why Judge Murphy reversed his judgment. It could be that Judge Murphy initially thought feeding appropriate for someone like Kasem, who was in an extremely debilitated condition, and then changed his mind. If so, feeding could be withdrawn from a patient who is expected to live but not improve, which would end the patient’s life. Some would call this euthanasia.
Or it could be the Judge Murphy based both judgments on consistent ethical principles, rather than a change of mind about a controversial practice. According to media reports, the judge based his final decision on a review of Kasem’s medical records, which by law are not made public. If those records showed that artificial nutrition and hydration could no longer have prolonged Kasem’s life or perhaps could not have been absorbed by his body, then the judge’s reversal simply allowed the withdrawal of a treatment that could no longer do its work, or had even become harmful to Kasem’s body. Kasem seems to have been in this condition because he died only a few days after withdrawal, while patients whose bodies have been absorbing nourishment typically live longer, as Terri Schiavo did for a couple of weeks after withdrawal. The judge’s reversal seems to have been following this rationale.
If so, it cuts against a rather disturbing trend in end-of-life care. Daughter Kerri Kasem sought withdrawal of artificial nutrition and hydration because her father’s advanced directive indicated that he would not want it if continued life “would result in a mere biological existence, devoid of cognitive function, with no reasonable hope for normal functioning.” Through his advanced directive, Casey Kasem was asking for death even at times when he would have continued to live, though in an extremely disabled state. By initially refusing to withdraw feeding, Judge Murphy declined to cooperate in bringing about Kasem’s death. It appears likely that, from the evidence initially presented to him, the judge had to assume that Kasem would continue to live and that withdrawing nutrition and hydration would cause his death.
The difficult question is precisely that: whether causing a patient’s death, by withdrawing nutrition and hydration, is a morally acceptable way for our society to relieve suffering. Descriptions such as “mere biological existence” are not helpful because they mask the human dignity that no condition can take away. I doubt that experienced caregivers of the severely disabled would consider their patients’ existence to be merely “biological” because those patients have permanently lost consciousness. It is easy to see Kasem’s wife, Jean, as completely irrational after seeing that ridiculous meat tossing video. Yet if anything in her bizarre behavior comes from a willingness to care for a severely disabled man, I will give her some credit for authentic love.
When the judge reversed his decision, it was not based on some sudden agreement with Kasem’s children to end their father’s life. Instead, he based it on a review of Kasem’s medical records, which perhaps showed that the celebrity’s body was no longer absorbing food, or that his lungs were aspirating fluid, or that death was imminent within a few days.
It is telling that a Catholic institution, St. Anthony Hospital, provided Kasem’s final care. Catholics have wrestled for several decades with when to provide and when to withdraw artificial nutrition. In a 2004 address, the late Pope St. John Paul II drew a conclusion that harmonizes with sound moral thinking as well as with Christian faith: artificial nutrition and hydration must be provided unless the body cannot absorb them, unless they cause physical harm, or unless they cannot reasonably be expected to prolong life. That standard respects both the dignity of the severely disabled and the natural contours of the dying process. Sometimes patients such as Casey Kasem require strenuous efforts from caretakers; at other times, the willingness of loved ones to say goodbye.
If the physicians at St. Anthony’s Hospital determined that continued feeding had become harmful to Kasem’s body or could not reasonably prolong his life and communicated that fact to the judge, then they too are to be thanked for helping bring peace to a tragic situation.