Terri Schiavo has been in the middle of a bitter right-to-die battle between her husband--who maintained she never wanted to be sustained on prolonged life support--and her parents. While this particular right-to-die battle is unique in its length and bitterness, similar situations occur almost every day--and I have witnessed this type of agony time and again as an intensive care unit specialist. I have seen family members get into fist fights and spouses cry in despair over what to do with their critically-ill loved ones. And it all stems from people not addressing the issue of the end of life.

Death and dying is not a very happy subject, and I can understand why many people do not like to address an issue as grim as what to do in case of terminal illness. But this decision is a very important one, perhaps one of the most important decisions one can make. If someone is faced with a terminal illness, what should be done? Should the doctors "do everything" or let nature "take its course"?

Most may think that the best course of action would be to always "do everything." Yet, I have seen many patients, including members of my own family, endure horrible pain and suffering as a result of "doing everything." Mind you, no malpractice is being committed, and everything is done according to medical standards of care. Still, these patients suffer horribly, enduring procedural complications and medication side effects with no hope of meaningful recovery.

One would think that-since I am a devout Muslim--I would be of the "do everything" persuasion because Muslims many times tend to be conservative on social issues. And I would "do everything" in the case of a reversible condition, such as a severe pneumonia that requires a brief stint on the breathing machine. Yet, if the condition becomes irreversible--if there is no hope for meaningful recovery--then many scholars of Islamic law have allowed life-sustaining treatment to be withdrawn. My grandfather died this way; and recently, so did my uncle.

This is out of mercy and compassion: mercy for the patient who has to endure the barbarity of modern medicine after it becomes futile, and mercy for the family members who, although they watch in horror as their loved one suffers, cannot bring themselves to make the decision to "pull the plug."

Does this mean that I do not believe in being aggressive in the intensive care unit? Far from it. I believe in giving my patients everything I've got to try to help them--by God's leave--get better and recover. Many times this works, and I have shaken the hands of people who were at death's door just a few days earlier. Sometimes, however, everything I've got simply does not work despite having some of the most advanced life-sustaining technologies available at my fingertips.

Some of these patients get worse and worse and die despite my best efforts. Others improve slowly and eventually recover, albeit with some permanent disability. Still others--and these are the most tragic and heart-wrenching--neither improve nor worsen from their original medical insult. They persist in the same state, half alive and half dead. Many of these patients have suffered brain and other organ damage from a prolonged period of low blood pressure either due to cardiac arrest, severe infection that caused an exaggerated and detrimental immune response, or stroke. It is these cases that cause the most agony for me and my patients' families.

When I see such patients, I ask myself, "Is this life?" Yes, they are technically "alive," with a pulse and blood pressure. Yet, are they truly alive? Can they watch the Super Bowl with their loved ones? Can they witness their eldest daughter graduate from college? Can they play with their newly born grandchild? Can they stare into the eyes of their spouse and still get that funny feeling in their stomach? What is more important: quantity of life or quality of life?

Now, as a physician, I would not even fathom to answer that question on behalf of any one of my patients. Yet, I know the answer to that question for me. After seeing all of the horrible things modern medicine--when it becomes futile--can do to do patients, I have vowed never to have that happen to me. I drafted a living will, which instructs that--if I ever were to be diagnosed with an irreversible medical condition--any and all life-sustaining treatment must be withdrawn. If there is no hope for meaningful recovery for me, then turn all the machines off and let me meet my Maker.

Incredibly sad scenarios play themselves out every day in our hospitals and intensive care units, and it does not have to be so. Family members should not be put in the untenable position of making life and death decisions for loved ones. There should be no more battles like that over Terri Schiavo.

Although it is an uncomfortable subject, every one of us should decide what we want to happen at the end of life, and then clearly communicate this decision to our families and physicians. If that decision is "do everything," that is great. The most important thing is to have a decision made, regardless of what it is, and it should be a decision made between one's heart, one's family, and one's God. State legislative houses and governors' mansions should have absolutely nothing to do with it.

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