248 M. Coombs and M. Woods
of death and the appearance of life be addressed? When considering
death in its various forms, discussions are often focused on body organs
and vital signs, with the capacity for the normal functions as a human
being stripped back to basic physiological mechanisms that are artifi-
cially maintained, and no more (Bernat et al. 2010 ).
However, what is less commonly understood and accepted are the cir-
cumstances surrounding the decision about time of death, and there-
fore the point at which life support is withdrawn. Here the differences
between what is clinically the case (from the doctor’s perspective) and
what seems to be the case (from the family’s perspective) are brought
into sharp contrast. It is in such circumstances that the degree to which
fully autonomous consent has been given by the next of kin for with-
drawal of the medical treatment becomes of paramount ethical impor-
tance. From the medical perspective, the patient has already died (Lazar
et al. 2001 ), but the family’s perception of signs of basic physiological
life (e.g. being warm to touch and movement) may lead them to believe
that the patient is still alive. It is of crucial importance that the family
be given information to make informed decisions at this time, and to be
able to give their consent for organ donation. This information needs to
be carefully considered, delivered with compassion for the family’s enor-
mous distress, and provided with an understanding that consent may
not be forthcoming.
Thus, the bioethical quandary that affects both clinicians and fam-
ily alike is the emotional need to cling to signs of life, while being
asked to make an objective decision to end them. Where the views of
the deceased are known, this can help the decision-making process.
However, such decisions may be much less clear when there is no prior
understanding, or when the family perceives their loved one to still be
alive, regardless of medical advice. In the end, Amy’s choice was a reflec-
tion of her mother’s autonomous desire to be of service to humankind.
CASE 2: Tesh’s Story
Letitia (Tesh) was 18 years old when she developed a cough and sore
throat. After visiting a doctor, she suddenly deteriorated at home, with
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