Faced with the agony of un-life, un-death

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AMESSAGE on the answering machine - one of several whizzed through as I jotted down phone numbers with one hand and removed outer layers of rain-soaked clothing with the other - stopped me in my tracks. The voice was blurred by emotion and distance; my comprehension was blurred because it was speaking French. But one sentence leapt out at me: 'Steve est gravement malade.'

I sat down, played it again, and rang Paris. It was true. Steve, a friend for 20 years or more; a joking, laughing man, kindness and generosity personified; fit, good-looking and not yet 50; Steve had suffered a major heart attack. By the time the ambulance arrived his heart had been still, his brain starved of oxygen, for 10 minutes.

They restarted his heart, rushed him to hospital where, as it happens, his wife, Mazella, works as a nurse, and wired him up to a ventilator. There he has lain ever since. He convulses occasionally, breathes as the machine dictates, while his heart beats strongly once again.

There is a more than usually dreadful irony here, in that for some years Mazella was one of a rota of nurses caring for the late Duchess of Windsor. The duchess lay, old and wizened, unable to move, speak or respond, while the pomp and luxury of a huge household continued to revolve around her. No one would take upon themselves the decision to cease caring for an aged woman whose past had been so spectacular and controversial, and whose present continued to generate employment for so many people. In the end Mazella could stand it no longer, and she left the gilded household to return to nursing people for whom a return to life and health was a real possibility.

Mazella knows, better than most, what is meant by 'a

persistent vegetative state'.

But Steve is the centre of her existence. They have been together for almost 15 years. Although they only married about six years ago and have no children, he is 'the man of her life'. Now it falls to her to take the decision to switch off the machines.

She knows already what she will do. When today's tests are concluded and the inevitable diagnosis - total brain death - is confirmed by yet more sophisticated readings, she will accept that Steve is dead, all except for his heart, and now the heart must stop, too.

But I want to ask: why has medical intervention compelled her to make this impossible choice? The interval between Steve's sudden cry from the kitchen, his collapse to the floor, Mazella's calling the ambulance and its arrival, was 10 minutes. Even I know that after 10 minutes starved of oxygen, irreversible brain-death has occurred. Why compound his wife's anguish by galvanising the heart back into motion; why attach him to a ventilator that keeps his cheeks rosy, his hands warm, his chest rising and falling?

Her grief at his death was always going to be harrowing. Now it will be made worse by half a lifetime of afterthoughts: did I do right? Might there later have been developments enabling doctors to re-activate the brain- dead? What about the miracle cases one hears of, when someone returns to consciousness after weeks of apparent death? Should I have prayed harder, had more faith? Have I betrayed him?

These are emotional questions that will, no doubt, infuriate doctors. But I feel emotional about my friend Steve, and the ordeal to which his wife is now being subjected. And they touch, yet again, on what seems to have become the central medical and ethical issue of our time: are doctors playing God? Do they believe they can blur, and eventually even extinguish, the boundaries between birth and death, being and nothingness, l'Etre et Neant? Prometheus played with fire and gave light and warmth to mortals, but doctors are playing with life and death, and thereby giving mortals choices that are sometimes too heavy for them to bear.

I am all for ensuring people 'a good death'. Palliative medicine, the control of pain, the ushering of the terminally ill gently through their final days, giving them time for the last goodbyes, the declarations, forgiveness and reconciliations that come at the end of many lives, is obviously a good and necessary thing. But why prolong the state of un- life, un-death, just because the machinery to do so exists? It is a question I have previously pondered only in the abstract. This week Mazella is facing it with agonising immediacy.

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