Some have called it a Right to Die case. Others have labeled it a Right to Live case. One group of advocates has called for "death with dignity." Others have responded accusingly, "euthanasia."
At the center of the latest controversy about life and death, medicine and law, is a 78-year-old Massachusetts man whose existence hangs on a court order.
On one point, everyone agrees: Earle Spring is not the man he used to be.
Once a strapping outdoorsman, he is now strapped to a wheelchair. Once a man with a keen mind, he is now called senile by many, and mentally incompetent by the courts. He is, at worst, a member of the living dead; at best, a shriveled version of his former self.
For more than two years, since his physical and then mental health began to deteriorate, Earle Spring has been kept alive by spending five hours on a kidney dialysis machine three times a week. Since January 1979, his family has pleaded to have him removed from the life-support system.
They believe deeply that the Earle Spring who was would not want to live as the Earle Spring who is. They believe they are advocates for the right to die in peace.
In the beginning, the courts agreed. Possibly for the first time, they ruled last month in favor of withdrawing medical care from an elderly patient whose mind had deteriorated. The dialysis was stopped.
But then, in a sudden intervention, an outside nurse and doctor visited Earle Spring and testified that he was alert enough to "make a weak expression of his desire to live." And so the treatments were resumed.
Now, while the courts are waiting for new and more thorough evidence about Spring's mental state, the controversy rages about legal procedures: no judge ever visited Spring, no psychiatrist ever testified. And even more important, we are again forced to determine one person's right to die or to live.
This case makes the Karen Ann Quinlan story seem simple in comparison. Quinlan today hangs onto her "life" long after her "plug was pulled." But when the New Jersey court heard that case, Quinlan had no will. She had suffered brain death by any definition.
The Spring story is different. He is neither competent nor comatose. He lives in a gray area of consciousness. So the questions also range over the gray area of our consciences.
What should the relationship be between mental health and physical treatment? Should we treat the incompetent as aggressively as the competent? Should we order heart surgery for one senile citizen? Should we take another off a kidney machine? What is the mental line between a life worth saving and the living dead? Who is to decide?
Until recently, we didn't have the technology to keep an Earle Spring alive. Until recently, the life-and-death decisions about the senile elderly or the retarded or the institutionalized were made privately between families and medical people. Now, increasingly, in states like Massachusetts, they are made publicly and legally.
Clearly there are no absolutes in this case. No right to die. No right to live. We have to take into account many social as well as medical factors. tHow much of the resources of a society or a family should be allotted to a member who no longer recognizes it? How many sacrifices should the healthy and vital make for the terminally or permanently ill and disabled?
In England, where kidney dialysis machines are scarce, Earle Spring would never have remained on one. In America, one Earle Spring can decimate the energy and income of an entire family.
But the Spring case is a crucial, scary one that could affect all those living under that dubious sentence "incompetent" or that shaky diagnosis "senile." So it seems to me that if there is one moment a week when the fog lifts and when this man wants to live, if there is any mental activity at all, then disconnecting him from life would be a dangerous precedent, far more dangerous than letting him continue.
The court ruled originally in favor of taking Spring off the machine. It ruled that this is what Earle Spring would have wanted. I have no doubt that his family believes it. I have no doubt of their affection or their pain.
But I remember, too, what my grandfather used to say: no one wants to live to be 100 until you ask the man who is 99. Well, no one, including Earle Spring, wants to live to be senile. But once senile, he may well want to live. We simply have to give him the benefit of the doubt. Any doubt.