Wednesday, July 02, 2008

Thoughts on Vegetables

The estimable Tobias Haller, has offered this as his “Thought for 7.02.08:”

Isn’t it strange that we take more care over a funeral than over a dying person? We treat the comatose dying person as ‘a vegetable’ (what an assault on human dignity!) but treat the dead body with incredible ritual respect. Haven’t we got it backwards or at least unbalanced?

He offered this “With special thanks and prayers for all who serve in hospice work and hospital chaplaincy, and those beginning their CPE this summer.” At the same time, I discovered I had very mixed feelings about the statement.

In part, I had these feelings after spending a couple of the wee hours of this morning at the bedside of a patient who ultimately died. I watched the careful, passionate, at times desperate attention of family members to the patient. I watched the thoughtful, sensitive, even tender care of patient and family members by professionals. Although the patient was past the point of offering any intentional response, I would not have connected the image of “vegetable” with the patient as seen in either the concern of the family or the care of professionals. And I hope you will trust me when I say this is consistent with my experience in more than 25 years in health care ministry.

In part, though, and in contrast, I have some feelings after walking with my wife in our back yard. In our modest back yard there are tomatoes and onions, peppers and eggplant, potatoes and melons and beans. There are tarragon and basil, oregano and sage, and berries black, blue, and rasp. We stopped to look at the peach tree, realizing that we need to spray more copper solution to control those spots on fruit and leaf.

That garden, and every crop in it, have benefited from careful, passionate, and sometimes desperate commitment. They have required thoughtful, sensitive, and even tender care. While they will not produce enough to sustain us through the winter, they will make a difference we will be able to appreciate. For a long time after their time in the garden, they will support us, as we supported them when they needed it.

I regularly hear patients and family members say, “I don’t want to be left a vegetable;” but they aren’t talking about the quantity or quality of care they expect to receive. (And yes, I do hear the same sentiment from professionals, if not in the same words.) Folks speaking of being “a vegetable” as a projection of their fears of being suspended, too ill or injured to live but too well-maintained to die. Indeed, if they worry about their care, most worry not about too little attention but too much. They worry about being maintained, sustained, as bodies with the mechanisms of personality gone. I certainly believe there is more to person or personality than brain; but with a brain unable to process sensory input and expressive output, there is no experience of dignity or indignity, or respect or disrespect. To worry about “being a vegetable” is to worry about whatever dignity the individual perceives, not about the dignity those around the individual express.

This is not to say there aren’t thoughtless families or careless professionals. As much as it appalls us – both those cared for and those providing care – they certainly exist. But, really, they’re not treating patients like vegetables, but rather like wildflowers: valued enough when they are pretty and flourishing, and entirely disposable when they are not. They are appreciated, and perhaps even cherished, when they bloom; and neglected, if not actively removed, when they do not.

We wrestle with this issue of dignity. We project our own fears onto the situations of others. Sometimes in our fear and our projection, we try to avoid realities as much as possible. But so much of the time it’s because we perceive the dignity of another as inherent and even God-given, even as we perceive our own as contingent on our capacities, whether to reason or to function or to relate. And even when family members make hard decisions, it’s almost never about the values of the person making the decision but about the values of the person in the bed: not “This is what I think best,” but “This person said he or she wouldn’t want to live like this.” We are willing to honor dignity in others, even to the point of acting on their expressed fears of dignity lost. What a paradox that is: to so honor another’s dignity as to accept that which we do not believe, that the person we care for has lost dignity.

That, of course, does have a parallel in funeral plans; but not in a way I find comforting. Many – too many - who believe their dignity is dependent on capacity will leave instructions not to “take care over the funeral.” To say, “I don’t want anyone to make a fuss,” is to say, “I’m not worth the effort.” Once again, it is about the individual’s perception of contingent dignity, and not about the wishes of those around the individual. And once again, many are sufficiently committed to respecting the dignity of the deceased that they deny themselves the opportunity to show the dignity they perceive in the deceased, or to dignify themselves in their own grief.

So, if we “treat the comatose dying person as ‘a vegetable’,” I think it is an expression, and not a denial, of human dignity. In fact the care in many ways does parallel the careful, intent work of the gardener, attentive and concerned, rather than neglect. Families and professionals may perhaps care too much, in the sense of exceeding the wishes of the patient; but they do care, and in doing so demonstrate that they indeed attribute dignity and value to the patient. They do care, often at the expense of body and mind and pocketbook, and even their own dignity.; and I am honored to have the vocation of caring for them.


Tobias Haller said...

Thanks, Marshall, for the response. You are clearly seeing the "vegetable" expression from another angle -- I suppose part of the problem with language with manifold meaning. My intent was aimed at those who use the term dismissively -- as if consciousness were the only quality of human life worth acknowledging. I realize not all feel that way, and God bless those who respect and work with and among the dying -- hence my prayers.

But I was also thinking of the phenomenon of the family members who never bother to darken the door of the hospital, but wouldn't miss the funeral -- which becomes a kind of substitute token for the care that might have been given.

No offense was intended for those who actually do care, and you have my great admiration for that work.

Marshall said...

Well, thanks, Tobias. I really did recognize the respect.

It's not really about offense, although I started there. I think you do highlight the paradox in our appreciation of human dignity: that often we will attribute to others dignity we will not allow ourselves.