LUTHERAN THEOLOGICAL REVIEW - Brock University

COLWELL: TO BE IN PAIN, OR NOT TO BE 7
physical recovery could not occur. However, for the sake of continuity I
shall use the word “hopeless” to mean what I hope Rachaels means by it,
namely, “physically hopeless” or “having no possibility of physical
recovery”.
Still, does the car analogy quite establish Rachaels’ point The problem
of uncertainty in the case of the two cars is not one of establishing their
identities, that is, not one of deciding what to call the cars once you know all
the facts about them. Rather, it is the problem of confusing the cars whose
identities have already been established. In Rachaels’ case the problem is
one of misidentification, not one of identification. 4
However, the problem of uncertainty in many cases of apparently
terminal illness is one of identification. Whether an illness can with
certainty be identified as “hopeless” is often the first problem with which we
should grapple in making an ethical judgement. The Rolls Royce will not
transform into a Mercedes while we are examining it closely; but a so-called
“hopeless” case might transform into a “hopeful” case, or at least a “less
hopeless” case, as we continue to look at it closely, however rare such an
occurrence has been in the past.
It is notoriously difficult to establish the truth of such negative
universal statements as: “there is no possibility that any terminally ill patient
of this type will ever get well.” One would have to know about all the
terminal cases of this type ever to have occurred, and then be able to say that
none of them went into remission. Moreover, one would have to know for
certain that no first-time remissions of this type could occur in the future.
This calls for an omniscience rarely found in physicians. Furthermore,
remarkable cases of so-called “spontaneous remission” have been
documented. 5
But let us grant that physicians do know for certain that some types of
cases are hopeless; for example, cases of anencephaly. We are still left with
the question of whether the numerous other types of “terminal” cases, most
of which are not so bleak, can safely be subsumed under the same category
of “hopeless”. Since there are degrees of hopelessness among terminal
cases, we should not want to use the certainty about the most hopeless of
them to establish warrant for VAE in all hopeless cases.
We have been thinking only about the prognosis of the physical state of
the patient. If we consider the prognosis of her psychological state as well,
our uncertainty is compounded. To be certain not only that someone will die
4 Neither the act of mismatching a name and an object nor the act of misapplying a
name to a vaguely perceived object is the same as the act of trying to determine the category
in which to place an unusual object which is clearly perceived.
5 For example, H. R. Casdorph, M.D., Ph.D., The Miracles (Plainfield, NJ: Logos
International, 1976).