The Battle of How to Die Right

Mr. T is a far cry from B.A. Baracus of the A Team. He is a frail, cachectic Asian man with a bowel obstruction. He sinks into his bed to the point that he disappears. You would think he is dead until he eerily turns his face towards you and speaks in mostly inaudible croaks and groans. He has an NGT (nasogastric tube) pumping out the contents of his gut- bilious fluid that, for some reason, never fails to remind me of the "ooze" from Teenage Mutant Ninja Turtles.

In simple terms, Mr. T is about to burst. He already had one small bowel obstruction last month that required surgical resection of a portion of his 80-something year old gut. He's spent weeks trying to recover, but his tenuous convalescence was complicated by necrotizing pneumonia, abscesses, and underlying depression. And now he's obstructed again. About to take another spin on the merry-go-round. If he doesn't get surgery soon he will burst, perforating his small intestine and spilling bile, bacteria, and shit throughout his peritoneal cavity. Infection would set in quickly, and he would die a rapid but excruciating death.

Mr. T has chosen this. He is declining surgery, opting instead to embrace death, however unpalatable the process. His family wants him to stick around awhile, and thus the Battle of How to Die Right begins.

I was working with the psychiatry resident on call when were consulted on Mr. T-- a capacity eval. The gist of the question was whether or not Mr. T had enough neurons in his noggin to make the decision for himself. Is he of sound enough mind to decline the operation? We set ourselves to the task. We battered the old shell of a man with a barrage of questions and tasks, including gems like identifying a picture of a rhinoceros (the poor guy thought it was a hippo, he must be deranged! No points awarded, by the way).

After much contemplation and verbal hand-waving, we determined that Mr. T lacked capacity. We stripped his autonomy to give up on this world. So sorry Mr. T, but we simply can't let you die the way you want. We ain't in the business of lettin' folks die round these parts. Reflects poorly on our stats. Nobody dies on our watch, y'hear?

I believe it was the right decision to not let Mr. T make his own decision in the state of mind he was in. Nevertheless, why should he get surgery? What is the sense in prolonging this man's life? Is it to comfort ourselves so we can say, "we did everything we could."

He is old, decrepit, depressed, and disabled. Is it just of us to fix his bowels without fixing his brain? Is it inherently cruel to save a man from an imminent death only to destine him to a slower demise by depression? The Battle of How to Die Right rages on....