n081  1635  19 Dec 82
BC-SAFIRE-COLUMN
Commentary
ESSAY: Fighting for Life
By WILLIAM SAFIRE
c. 1982 N.Y. Times News Service
    WASHINGTON - At Kennedy Center Saturday night, in the revival of the
Rodgers and Hart musical, ''On Your Toes,'' the Russian ballerina
Natalia Makarova was about to begin the ballet ''Slaughter on Tenth
Avenue.''
    In the musical's plot, the jealous villain had vowed to harm a male
dancer in the ballet. As if on cue, a ripping sound was heard as a
large chunk of scenery came crashing down on stage, and a length of
pipe slammed into the fragile-looking ballerina.
    She cried out and kept on sobbing. The curtain was lowered. The
stunned audience realized that the accident was not part of the show;
after waiting vainly for word of her condition, the audience somberly
filed out.
    Remembering that I worked for a newspaper, I went backstage to file
a report: Miss Makarova, who defected to the West a dozen years ago,
was being lifted into an ambulance; an attendant said she had
received head lacerations and a fractured shoulder. Sunday her
condition was reported to be fair. She was lucky; a few inches the
other way and the falling pipe might have killed or crippled her.
Perhaps her white wig provided some protection.
    An incident like that snatches thoughts away from the entertainments
of politics and directs them to the very thin line between life and
death.
    Since this took place in Washington, the talk in the opera house
lobby drifted to the way that the unexpected - an accident, or a
shooting - can scramble the patterns of political life. Miss
Makarova's friend, Ann Getty, drew the parallel of the danger of an
accident in a world of many nations armed with nuclear weapons.
Nothing so underscores the value of life than the sudden realization
of its fragility.
    It started me thinking about Barney Clark, the man with the first
artificial heart. He knew he was about to die; he gambled on an
untested machine, which later broke down and required another
operation to repair; he cannot know what chance he has of pulling
through.
    An editorial in The New York Times, after praising Clark's courage
and wishing him well, raised a troubling issue: ''Can all that pain
and exertion be worthwhile? The purpose of medicine is to improve
life's quality, not to make Methuselahs of us all. ... Dr. Clark made
his own choice, but many would decide death is preferable to being
permanently tethered to a bulky machine, without hope of release.''
    I'm glad that editorialist is not my doctor. The purpose of medicine
is not only to improve life's quality but to save lives. If, in the
process of averting death, a patient chooses to become a human guinea
pig or to marry a bulky machine, the patient has the right to demand
that the medical profession let him make that choice.
    Yet the editorial is accurate in saying ''many would decide death is
preferable.'' That is because too many people treat life as a
possession that becomes dispensable when it becomes too onerous.
Suicide, as one hospital administrator said in dead seriousness, has
become a viable option.
    This is wholly aside from the issue of keeping a long-comatose
person on life-support systems or of berating those who elect not to
prolong unbearable pain. Clark's case shows that criticism is growing
of those who fight for life, who refuse to go gently into that good
night, and who annoy the healthy with their quest for new drugs or
undignified procedures. Wanting to live - against all odds - is
derogated as Methuselism.
    The play ''Who's Life Is It Anyway?'' made a hero out of the patient
who demanded his right to die. The curious new fashion is to praise
those who are willing to go quietly, hailing as courageous those who
smile sadly and don't make a fuss. At the same time, patients who
refuse to resign themselves to the seemingly inevitable are viewed as
pushy, and doctors willing to go to the frontiers of medicine are
derogated as aggressive.
    Fortunately, we Methuselists have real-life dramas. Barney Clark is
not prolonging his life because he is courageous, he is prolonging it
because he does not want to die. In this display of the God-given
instinct for self-preservation, Clark voluntarily advances the
technology of artificial organs. In a few years, other ''hopeless''
patients with other ailments will press researchers into the practice
of brain transplants.
    Is it ethical to fight so hard to live? An orthodox rabbi in
Jerusalem is reported as saying that a man with an artificial heart
has no right to call himself a human being; I wonder if a clergyman
so heartless has the right to call himself a rabbi.
    The fierce determination to live can affect health and astound
physicians, causing seeming miracles; it would be immoral to deny
available technology to the Barney Clarks of the world who are
carrying the fight for life to new heights.
    In all the new emphasis on the quality of life, a ballerina's brush
with death is a vivid reminder that life itself has a quality not to
be scorned.
    
nyt-12-19-82 1933est
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