I was the physician in charge of the emergency department when the EMT’s raced in with the patient, CPR in progress. The staff was ready, and we did what we do, quickly assessing her heart rhythm and defibrillating her, inserting a breathing tube into her trachea, pushing the requisite drugs into her veins, and working so her heart would beat strongly enough to pump the blood on its own. Her blood pressure was still dangerously low, but we had drugs for that too, and everyone in the room began to relax, smile even, as we saw we were succeeding once again in that great privilege of stealing a life back from death.
The door opened just a little, and a nurse looked in at me. “Her husband is here,” she said.
I went out to see him, happy that I could give him, cautiously, good news. His face was a picture of fear and anguish.
“You have to stop,” he said. “She didn’t want this.”
Stop? I thought. We can’t stop—she is alive.
He poured out her story: cancer, years of treatment, side effects, recurrence, bone pain, disability, decline, despair, goodbyes. Her chart, which by now had arrived, confirmed all this.
“I don’t know why I called 911,” he said; “I was just afraid.”
My mind, which only a moment before had dwelt in the pure existence of struggle and triumph, suddenly became a noisy room of conflicting voices: responsibility, regret, pride, policy, uncertainty, rules, success and failure, oath and obligations.
“Stop, everyone,” I said as I re-entered the trauma room.
Nurses, techs, EMT’s looked at me with disbelief. “She has a pulse,” one said.
“She’s DNR,” I said. “She doesn’t want this.”
Silence. People looking at each other, a shuffling, some walking slowly to the door. It was clear not everyone agreed with this decision.
We pulled out the tubes, stopped the IV drips, and turned off the monitor so her heartbeats would be invisible. Her husband asked me to stay, and I did, until she died.
How does one ever know what to do? As an agnostic, I have no authority to turn to and no book in which to look up the answers, and I distrust absolute moral principles, because they are forever coming into conflict with one another.
Thus I have nothing to go on but my experience of life, actual and vicarious—the joy, pain, love, loneliness, suffering, and hope that we all feel, from which come our sense of our common humanity, empathy, a sense of decency. These things have led me to a simple rule, one that over the years I have come to trust, one in which I believe. It is this: Always try to do the right thing.
Before you laugh, I will acknowledge this principle appears so vague and so devoid of clear direction as to seem no guide at all, but I believe that in its apparent vagueness it contains the elements that allow one to find a way in the moral thickets of everyday and not-so-everyday life. It implies first of all that in most cases there is a “right” or at least a “better” thing, and it implies that we have an obligation to discover what that thing is, and to try to do it. It implies that one must have a conscience.
I believe the common elements of human existence—the desires, fears, sorrows, loves, even the selfishness and cruelty— are variables in a kind of algebra of ethics, each bearing the weight we give it in the complex imaginary equations that determine the choices we make. We will not all agree on the weight to give each element, and thus our choices will not always be the same. I have no solution for this problem, if indeed it is a problem.
I have only to ask myself if I tried, really tried, to do the right thing in that trauma room years ago, and in the countless other times and places since, and those to come.
I hope I did, and I hope I will.
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