A Theosophical Exploration by Audrey Brimson. Presented by the Adelaide Theosophical Society. Radio 101.5 Feb 16/2014. Duration 20 minutes
Welcome to “Within TheoSophia” Theo means divine, Sophia means wisdom. This program is about recognising the divine wisdom within each of us.
Presenter Hi There. It’s good to be with you this morning. “Do not resuscitate!”
In today’s program we have the opportunity to explore with a theosophist, how one might go about making sense of this very confronting statement. With me is Audrey Brimson who has been a member of the theosophical society for over 30 years, and who also comes from a nursing background. Welcome Audrey. and thank you for coming in today to share your thoughts with us.
Audrey. Thank you. It’s good to be able to discuss such a pressing issue.
Pres: Audrey. I understand that you came across this statement just recently. Can you tell us about that?
Audrey. Someone I knew very well suffered an extremely severe cranial vascular accident, she was not found for about 10 hours and on admission went straight to theatre. After the surgery her chances of survival were put at 1%, and relatives were told if you want to see her – come quick. They did come quick, from interstate, and several days later with very little change in her condition were asked if they would agree with organ donation. They agreed; so the time was set for them to be there when the machines would be turned off as by then all the arrangements for organ donation had been put in place.
Anti-climax! When all the equipment was removed voluntary breathing recommenced, so organ donation was abandoned, and the equipment replaced. The patient’s condition was still extreme, deeply comatosed and no reactions. Advice was given to clear up all her affairs and then the agonizing question “Do you agree with ‘Do not resuscitate’?” This caused considerable discussion and soul searching but the eventual answer was “NO”.
Against all expectations of a vegetative state and extensive paralysis, over the next few months, there was a very slow recovery of consciousness, from eyes open but completely blank, until now, smiling, recognizing relatives, feeding herself, walking and trying to increase her ability to talk again. The word ‘miracle’ has been used as nothing else seems to account for the recovery in view of the extreme swelling & damage to the brain that apparently had occurred.
Pres: Audrey, that’s an amazing story, and placing myself in it, if I was the relative having to make that decision not to resuscitate and I had been considering the answer of “yes” I would have found it very difficult to deal with how things turned out. Is this a one off in your experience. I mean how often can this happen?
Audrey. It is not an uncommon predicament. “Do not resuscitate” is a statement that seems to be reverberating around the community at the present time.
Pres: Why do you think this is?
Audrey. Well, possibly for two reasons,
- the increased life span with 70 being the new middle age and
- the almost unbelievable technology available that causes considerable confusion when deciding that a person is actually and irretrievably dead.
Pres: So are we talking about a very different perspective now - from when you began your nursing career?
Audrey. Yes, absolutely. During my training I vividly remember hearing a young doctor saying one day, ”Not officiously to strive, to keep the dying patient alive”.
Pres: That’s an amazing statement. Officiously? What do you think he/she meant by it?
Audrey. I suppose the easiest answer is ‘not to go beyond the limits of common sense’, which can happen sometimes, but as sense is not always common that also defies definition. The ‘Officiously’ part is when one has gone beyond, “enough is enough”, again a very subjective conclusion.
Pres: It all sounds very subjective, so is that very different today?
Audrey. The doctor in the 1950s, added “Don’t flog a dead horse”, a more confronting image, but we do not attach horses to artificial respirators, use defibrillators or heart lung machines, therefore the question of whether or not to turn the electricity off does not become an immediate and pressing issue. Technology and the ability to artificially sustain the basic functions of the human body has made it a huge issue for contemporary society, particularly Intensive Care staff and relatives, especially when tied in with the possibility of organ donation.
Pres: Yes I can see that - but surely underneath all of this there is the same duty of care that has always been there for medical staff.
Audrey. Yes. In a way - the central issue is the same but with far greater complexity. Nowadays with the incredible advances in medical science inevitably one more often hears that relatives have been asked if they agree with the request, “Do not resuscitate”.
Pres: And how are people expected to deal with this? From your story, I can see that it could be a very difficult decision to make for most of us.
Audrey. Yes, it’s certainly a confronting statement. But I think the first thing we need to do is to really think about what it means - in its simplest terms.
Pres: And what does it actually mean?
Audrey. It means taking extra-ordinary and prolonged measures to bring the patient ‘back to life’.
Pres: So the patient is presumed “dead”?
Audrey. Well, usually it means the patient is flat-lining
Pres: Which means?
Audrey. The heart has ceased to beat, there is cardiac arrest and the cardiac monitor shows no evidence of movement. The term cardiac arrest can be misleading too, as ‘arrest’ is not seen to be a permanent condition, handcuffs can be taken off and hearts can often be shocked back into a sustainable rhythm.
Pres: Well, if this is misleading, then what is a better way of saying it
Audrey. The more important diagnosis is ‘brain dead’ where there is proved to be a cessation of brain activity, this is legally complex and defined differently in individual countries.
Pres: The term ‘brain dead’ seems to imply that only part of us is dead, the brain; but the rest is still potentially ‘alive’. Am I getting this right?
Audrey. Yes, there can still be function. in the presence of this condition, respiration, heart activity and nutrition can be artificially continued for an indeterminate period of time. If you look on the web it is obvious that a confirmation of death can be a legal and medical minefield. In the Wikipedia article about brain stem death I very much appreciated the comment. “Perhaps the most objective statement to be made is that consciousness is not currently understood”.
Pres: Well without a clear understanding of consciousness how can we even begin to make sense of it. I mean most of us would wonder, without obvious brain function, who is it that is alive?
Audrey. Yes, correct, the body can still be functioning on a basic level but the question is, is the person alive? Does the spirit of that person we know, still inhabit the body? Is there any degree of human consciousness present?
Pres: Woah! You’re using a couple of interesting, dare I say controversial terms here. You’ve already stepped into the controversial area of “consciousness” and now you are raising the idea of “spirit”. So I’m presuming that you are moving beyond the medical paradigm now and starting to explore the issues from a theosophical perspective.
Audrey. Yes. Well let’s look at spirit first. We need to come to a basic understanding. Are we a body that has a spirit? or a spirit that has a body? There is a difference. If we are a spirit that has a body then when the body dies the spirit is actually released to continue in another form.
Pres: Another form?
Audrey. Yes, in a different state of consciousness, whether discarnate in spirit form or, as many cultures believe, that the ongoing causal body will reincarnate in a new body to enable the continued evolution of consciousness.
Pres: And what about if we view it the other way, that we are a body with a spirit.
Audrey. Well, if we are a body that has a spirit, then we are inclined to think that there is nothing beyond the death of the physical body, some people think that spirit is synonymous with breath, therefore if breathing has ceased that is it!. This again is a very complex subject which for the sake of brevity today I am dividing into two
(1) The consciousness or spirit which some contend is only to be found in a living physical body and
(2) Consciousness or spirit that extends before and after what we call a physical ‘Life’ and reincarnates as a completely different personality but with the same indwelling spirit.
In theosophical terms sometimes called the ‘Cycle of necessity’, that is, we keep coming back until we graduate – (become Self-realised.)
Pres: OK so it makes more sense to view it that we are a spirit with a body if we are wanting to explore the possibility of the continued existence of that spirit.
Audrey. Then the question that arises is, has our spirit lived physically before and has our spirit the potential to live physically again?
Pres: I suppose this is one of the most basic “religious” questions that has been asked, no doubt from very early on in our history.
Audrey. Yes philosophers and religious pundits have argued about this for millennia, but the question I ask myself is, if it is true that our spirit lives on, why on earth - literally, why on Earth? do we fight so hard to maintain life in a physically compromised body?
Pres: Why, indeed?
Presenter. Today I’m talking with Audrey. Brimson, a long-time theosophist with a nursing backing, exploring the statement “Do Not Resuscitate”. What it means medically and how we can make sense of it.
Pres: Audrey, before the break you raised the question of why, if our spirit lives on, people fight so hard at times to maintain life in a physically compromised body. I know that over the years you have had a wide range of nursing experiences, so I’m presuming that you’ve been in the situation of witnessing this.
Audrey. Yes. as a nurse and midwife, I have seen the delivery of a ‘flat’ baby - a baby that was white, no pulse, completely atonic, not breathing, to all intents and purposes lifeless. In modern terms with an APGAR score of zero, literally, “no-one home”. Then inexplicably, sometimes after a period of time or effort, there was a sudden gasp of breath, the skin colour became pink, muscle tone was reasserted. the baby was alive; what was the difference? The entry into that little body of its spirit? Could we take the credit for that?
Pres: What do you think?
Audrey. I do not think we can take credit for it.
Pres: And what has been your experience at the other end of this lifetime, the time of dying?
Audrey. It’s the same when life ends. Even when deeply unconscious there is an obvious and definable change when the spirit departs. There is a vital difference between an animate and an inanimate body.
Pres: So what do you make of this?
Audrey. I’ve thought a lot about it and it seems to me that in spite of what we as nurses and doctors may actively do or not do, ultimately it is a decision by the individual spirit that determines the existence of what we call ‘life’ in a physical body.
Pres: And what about if the medical intervention is at odds with the spirit’s desire to move on?
Audrey. Sometimes when vegetative life is retrieved by extraordinary means, the ‘life’ that is apparently restored and maintained is not worth living. This would be extremely controversial in the western world view, but if the spirit has only a tenuous contact and is not learning anything further - then assuming that life is a co-creation I can only suggest one has to look at what the people around them, either related and/or caring for them are learning by their continued presence. There is a lot to learn when looking after a totally incapacitated patient. The first and final injunction to the medical profession is to - do no harm
Pres: And how does one decide on what is “harm”?
Audrey. Do no harm is known in Sanskrit as Ahimsa. It is very important in the teachings of both Vedanta and Buddhism.
Pres: Important in what way?
Audrey. It is important in several ways. The main thrust in ongoing human development is to develop love and compassion, not to be concerned primarily with ‘self’. To show more responsibility, which means the ability to respond with the heart, with compassion. A more basic understandable reason would be tit for tat, you get what you dish out, do unto others as you would have them do unto you - otherwise known as karma, which can be good or bad, and is a scientific reality known as action and reaction.
Pres: So in coming to a decision about resuscitation that involves doing no harm I’m assuming that nurses and doctors work as part of a medical team - are there other professional people in the team who can assist?
Audrey. Yes Social workers, they often ask a question - “Whose needs are being met?” and this is a question which needs careful consideration by medical staff - by relatives - and last, but not least, the patient - who at this point is rarely able to give an opinion.
Pres: I can understand why you’re saying it’s important for the medical staff and relatives to ask themselves this - but how can the patient be involved?
Audrey. There are numerous reasons why people make a living will. They have seen someone they love in an intensive care unit and do not wish their own life to be sustained by the use of machines, to be in untreatable pain, nor to leave such an agonizing decision to people they love.
Pres: So from what you’re saying, it’s so important that we take responsibility for having this in place before anything happens to us, so that everyone involved is clear on what it is we want. And as someone who has nursed dying patients are there any experiences or understandings you can share with us?
Audrey. Not really, back in the latter half of the C20 obviously some people we were treating died but there was a different attitude, looking back I think, in many ways, a healthier one. I remember Elizabeth Kubler Ross when speaking in the Adelaide Town Hall saying, “Sometimes the healthy thing to do IS to die”. The challenges in Emergency were very different then, things seemed more logical, the inevitability of the end of life more obvious, generally more acceptance and not the same frantic urge to intervene. Perhaps also, sadly, not the ever-present fear of litigation either.
Pres: And what do doctors make of all this?
Audrey. Good question. Recently there was an article in the Advertiser stating that a doctor in QLD had expressed the opinion that if more elderly people recorded their end of life wishes and informed their relatives it would save the State a lot . . .of . . . money. He is right – but might it not help the patients and those close to them too? For all concerned it is all too easy to be caught up in the stress of the moment. So much of what we do is guided by routines, in a given situation a well-practiced team works efficiently to achieve certain outcomes, it is possible for the routine to become the dominant issue, for a while there is not even a fraction of a second to stand back long enough to be the observer and say, “Is this justified?” . . . or . . . ‘stop!’ And this leads us into the question. Why do people die? Again, a question that has been asked since humans were capable of thoughtful observation and love.
Pres: Thoughtful observation I understand, how does love enter into it?
Audrey. When we love someone the pain of impending separation is great. Naturally we do not wish them to go, why must they go? A frequent request is ‘Please do everything you can to save their life’ A different point of view is that we have a journey to travel in our lifetime, however extended or brief. That our life journey does involve other people is obvious, that it is a co-creation by all involved, is not. Also, somewhat obscure and debatable to most people, is that we leave either when we have accomplished what we came to do - or alternately - when we can no longer reach that projected goal in this lifetime. Some others would say there is no rhyme or reason, life is capricious, and we should sustain it by whatever means are available, that this life is all we have and all we will ever have.
Pres: So our views on what the meaning of life is will certainly give a different perspective from which to view the decision.
Audrey. Indeed, for people whose tradition brings an acknowledgement of the reality of reincarnation they will probably be comforted and reassured by the belief that they have shared lifetimes before and in the added knowledge that love attracts will probably share lifetimes again, therefore the desire to prolong an unpromising situation loses its attraction or hold. “Do not resuscitate”. There is such a sting in that decision that often it will continue to smart in the person that makes it for months, even years and the question, “Did I do the right thing”? can haunt one’s thoughts.
Pres: So apart from our own understanding of why someone dies, are there any other understandings that can be helpful in clarifying the decision?
Audrey. It would be remiss to leave this subject without mentioning the many books containing thousands of accounts of Near Death Experiences, books that have been written by medical practitioners who have been drawn to study and record what they have witnessed or been told by their patients. Some doctors have also been spurred to write by their own NDE which has convinced them of the fact of life after death, and that for some specific reason they returned.
Pres: So in these accounts why do people say that they didn’t die?
Audrey. People usually say it was their own decision, that a mother did not want to leave young children, or that they were advised to return by a deceased relative; or a revered spiritual figure convinced them that they had significant things yet to achieve. No-one ever said they returned because they were jolted by cardiac defibrillators.
Pres: Well that’s interesting. What do you make of it?
Audrey. To physically live or to die to me is the decision of the individual spirit. We cannot adequately account for it either way, but if someone ‘lives’ who was ‘dead’ we call it ‘a miracle’, and miracles are things which currently science cannot explain. We do say it don’t we? that someone we know has a wonderful spirit that keeps them alive, but do we actually look at what we are saying and if we do, do we mean it? So, resuscitate using short term or long term extra-ordinary methods? Or, do not resuscitate? Perhaps, on behalf of someone else, the decision is never ours to take or implement anyway.
Pres: Thank you so much for sharing your observations and insights today Audrey. . . . as well as your medical knowledge.
Audrey. It has been my pleasure.
Pres: It certainly gives us more to think about should we find ourselves in this situation, and it sounds as if, with our increasing technology, the chances are that we will be asked to make this decision for someone we love.
And a reminder to the listener, as with all theosophical explorations. there are no answers given. Theosophy does not dictate a position on any issue but rather provides a background for consideration. Each of us must find our own truth.
Thank you to Audrey for sharing her experiences and perspectives with us today