As my wife and I age, we have seen many instances of people unprepared for end of life issues. Thus, we have put into place durable power of attorney, living will and other necessary documents. We have also discussed them with our family. We are not attorneys or legal authorities; we consulted with others.
ln a review of Ohio law, it is apparent that much thought has been applied to the details for "withdrawing or withholding" end of life sustaining treatment. I believe Ohio lawmakers should apply the same reasoning and principles to decisions occurring at the beginning of life.
This section of the law on end of life treatment details how physicians or family members may make the decision to understand when the heart has stopped beating and/or the brain may no longer be able to make informed decisions or recover in the future. Also, if I or anyone else has expressed our desire to have such a decision made ahead of time, this is included in the process outlined.
The law details which family members may make a decision to end the support and there are provisions referring to the immunity applied to those involved in making such decisions.
These decisions are to relieve the family (as well as society) from the cost and suffering of maintainingan individual who may no longer be alert or aware, let alone care for or about themselves or others. Iwish not to be a burden when my life is ending.
There are numerous published references guiding physicians and other caregivers on the process ofdetermining brain death. These point out that most of the determining factors on brain developmentand function can be applied after about one year of life.
Other published materials from the National Institutes of Health on early brain development outline attempts to study fetal brain development, which is obviously difficult while it is still in the uterus. Some studies have been performed on infants born prematurely. These reports outline the challenge of assessing brain wave function as well as the ability of various areas of the brain to support life.
Thus, both structural and functional brain development is needed before the unborn fetus may be able to sustain life on its own. This occurs somewhere in the third trimester. There are some reports of premature infants born before 22 to 24 weeks who survive with great risk, cost and potential for future health problems. Exceptions do abound concerning that.
My point is that the Ohio legislature has outlined detailed end-of-life decision-making tocredible and qualified professionals, as well as assigning that decision to spouses, children, parents, etc. I also get to make my choice known to others.
The unborn fetus/infant, obviously, cannot make a decision, but that should not be up to the legislature. Standards and criteria are not at play. Pregnancy termination before the likely viability of the unborn (perhaps 20-22 weeks) is up to the parent(s). ln the event of a birth defect inconsistent with life or viability or for the safety of the mother's health, the latter would seem paramount.
Pregnancy termination whether pharmacologic or surgical is not without risk to the woman. Those risksare dependent upon many factors.
Determinations of the "age of the pregnancy," even by ultrasound, are arbitrary — an estimate. Many women do not track their menstrual cycles. Many are not aware they may be pregnant if they are two to three weeks or more late for a menses. Urine pregnancy tests may be negative for a while after a pregnancy begins. It is not always easy to access a medical professional. lt is thus not uncommon for women to be 10 plus weeks along before they consider they might be pregnant.
Certainly, the morning after pill is available for someone not practicing safe sex or someonewho has experienced an unwanted, undesired or forced episode of intercourse. However, it is lesseffective later in a pregnancy cycle.
I have outlined what is codified for the end of life. It is inappropriate, if not unconscionable, to set a standard for end of life decision making and not to do the same using the same criteria for the beginning of life.
Ross Black of Akron is a retired family physician.
This article originally appeared on Akron Beacon Journal: Decisions on abortion, terminal illness can be made similarly