The passing of disc jokey Casey Kasem has generated a remarkable volume of bioethical commentary. Artificial nutrition was withdrawn from an unconscious Kasem in light of an advance directive he had written. The directive was vague, and some of Kasem’s family objected to move.
Nancy Berlinger, lead author of the Hastings Centre Guidelines, says that the specifics of one’s end-of-life preferences must be discussed with family.
Kasem’s directive stated that he would not want to be kept alive if it "would result in a mere biological existence, devoid of cognitive function, with no reasonable hope for normal functioning."
"What does it mean to have 'no cognitive functioning'?" asked Berlinger.
Daniel Johnson of Permanent Care Management Institute agreed: "When people take time to have discussions with family to ask the right questions with all important parties, you almost never see this," he said.
Bioethicist Wesley Smith proposed a framework that should be applied in all such cases: "The key factual and ethical question here is whether his body is shutting down as part of the natural dying process. In that situation, people often stop eating and drinking spontaneously. In such cases, it can be medically inappropriate to force sustenance into a body that can’t process it."
Mark Kuczewski, chair of the Neiswanger Institute of Bioethics at Loyola University-Chicago, said that Smith’s distinctions might not be so clear: "the point when patients stop processing or enjoying food is not so clear cut." Kuczewski suggested that families err on the side of caution.
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