Dying and Being Born - Two Lines Crossing Obstetrics in the Light of Two Worlds (Original title: Sterben und Geborenwerden kreuzen sich. Geburtshiife im Lichte zweier Welten. Merkurstab 1994; 47: 452-6. Reprint- ed from Die Drei I, 1994. English by A. R. Meuss, FIL, MTA. [See also the articles by Paolo Bavastro and Nick Lee in JAM 1995; 12 (1)]

What happened?

The destiny encounter with Gaby Siegel has meant a lot to us, throwing a clear light on and helping the development of our community hospital, the Filderklinik, as well as making us into a working community beyond the boundaries of medical specialization and occupational groups. Picture the following: a large group of us has gathered: male and female nurses, art therapists, physicians from the departments of internal medicine, anesthesia and intensive care, gynecology and pediatrics, midwives and the hospital chaplain. Questions of giving birth, being born and dying, the destiny of the human being, live in our hearts. We speak of our experiences in the treatment of Gaby Siegel, the young who is a deep, death-like sleep in the intensive care unit. Her cheeks are warm and rosy as she sleeps. We all feel that she is alive, is with us and takes part in music, speech and eurythmy therapy, physiotherapy and medicated rubs. The anesthetist turns off the respirator and ventilates the patient manually on these occasions.

He monitors her heart beats and blood pressure, skin color and perspiration with great care. Everybody talks to Gaby Siegel. The child is growing and moving in her womb. The midwives palpate the mother's abdomen to feel the child's movements and check how far the womb is ready for labor. They also monitor the fetal heart beats.

Karl-Eugen Siegel is with his wife for many hours each day, carefully observing her and learning how to look after her. When the EEC shows a "zero line," which by present standards means that Gaby Siegel is "dead," he is still convinced that she lives: "that Gabs (Gaby) and I are of one mind, with my thoughts also hers, and hers mine... I had a number of talks with her again today, and we decided on the individual responsibilities each of us would have for the child. We also agreed that life would go on for and with the three of us."

Karl-Eugen Siegel refuses to have an amniocentesis done, being prepared to live with a handicapped child if need be. Before his wife became unconscious they had decided to have the delivery at the Filderklinik. He is convinced that the mother-to-be is "able to take care of our child in the spirit" even in her present condition.(1)

As we share our thoughts, cares and hopes, turning to one another in empathy, a therapeutic community develops, and we gain the strength we need to make difficult decisions and take responsibility for them. Access to the patient is much more extensive and human than can be recorded on an EEG. Science reduces all human communication to brain currents, and this closes the door to new ways of perception. Gradually individual intuitions develop in the group, and increasing calm, courage and confidence create a basis on which judgments are made with growing certainty, despite all the uncertainties, worries and doubts we feel. New strength is gained as we face our task, and all this is much too delicate, needing protection initially, to stand up to the type of discussion presented in Info(3) now, two years later. Public demand tends to be that everything should be clearly understood and decided before action is taken, so that each of us would only do what we are already capable of doing. In this case there would be nothing new in the world, and no one would learn anything new relating to his work.

Another world

Compared to our "inner world," the treatment of the subject in Info(3) ("the somewhat different paper on the subject of Anthroposophy") seems like another world, missing the point and non-constructive:(2)

1. The "Filderstadt - Eriangen - Oak- land" parallel they draw goes against the uniqueness of every birth, every destiny, the individual encounter we endeavor to make.

2. The dogmatic prejudice according to which the approach to and treatment of the unique individual seems "absolutely out of the question for fundamental ethical reasons" made the Info(3) authors experience a helplessness that led to longing for an anthroposophic moral encyclic. When Dr. Frank Meyer and Ramon Bruell expect "help from the anthroposophic study of man" on this very point, they must inevitably be disappointed. This is due to the "somewhat different" view of Anthroposophy represented in their article.

3. This erroneous view also influences the authors' method of research: They address their enquiries to the Leader of the Medical Section at the Goetheanum in Dornach, Switzerland and the Council of the German Anthroposophical Medical Association. To my knowledge, no one who was actually involved has been addressed. Calling us "white-coated anthroposophic demigods" they suggest a hierarchy of responsibility of the authoritarian kind known in the former GDR, for instance. Characteristically, Frank Meyer and Ramon Bruell suspect we live in "a world of secret services."

4. All other reports known to me from radio, daily press, journals and television were free from prurient curiosity, officiousness and sensationalism, respecting the professional discretion which, in the given situation,was absolutely vital. Looking back, it seems like a miracle that we found ourselves protected from unqualified public discussion for almost two years, despite the fact that everyone in the Klinik knew about it, and the "Eriangen baby" story had resulted in sensationalization of the topic. Even the radio interview given by Thomas McKeen did not cause a wave of public indignation. He had obviously succeeded in convincing listeners that this was a unique situation that did not compare with the Eriangen case. I think we owe even more than this to his clear, assured bearing and a modest approach that engendered trust.

About two years later, the media did publish as much as the father, Karl-Eugen Siegel, was prepared to tell. The journalists were clearly aware of the significance of this destiny knot. They showed respect and understanding regarding the difficulties of making decisions in this border area. Their attitude reflected the dignity of illness, giving birth and dying.

A step forward?

The fact that Maximilian Matthias Siegel, "God's greatest gift" to go by the name his father has given him, lives on earth today - outward success, therefore - cannot be the standard for determining the appropriateness and usefulness of an action. Are there other sources from which certainty may be gained? A question that may help us to get our bearings would be: what consequences for ourselves and others can already be seen and how far do we accept the consequences gladly, joyfully, or with pain?

The meeting between the Siegel family and Thomas McKeen, and his decision as a physician, to connect himself with their destiny proved a strong impulse that took hold of the whole Klinik. Individuals were able to relate to this initially because they trusted Thomas McKeen and then increasingly on the basis of personal experience, growing intuition and insight.(3)

This meeting made it possible, and indeed demanded, that questions of life before and after death became part of every thought; it is only by considering the world of the spirit and the law of destiny that we can ask about the meaning of such a situation and learn to make decisions that are in accord with reality. An intensive care unit is a sphere of human life where technology rules more than anywhere else we can think of, with other people and machines taking care of many vital functions connected with movement, metabolism, circulation and respiration from outside since the patient herself was unable to be in waking consciousness and determine her own actions. In this situation, her immortal individuality came alive in the hearts of the helpers, people who consciously addressed the whole human being. They had a feeling for this when they said: "She's with us." It was this which gave Karl-Eugen Siegel the certainty: "She's alive." His perceptions were at a higher level than those provided by an EEC: "I do, however, ask myself if it is possible for someone who is alive, even if only with the assistance of a respirator, to be declared dead... I think they're all off their rockers!"(1) That would be how people must appear to those who only see the scientific level or believe it to be the only level they are allowed to see (because of insurance regulations - who pays the medical expenses of someone who is "dead" and how is the formality of a death certificate handled for a "corpse," legally speaking an "object").

The observation and treatment of Gaby Siegel continued for many weeks. It gave new impetus to Thomas McKeen in his efforts to find new ways of looking at the dying process, developing his own approach in opposition to current views according to which death is defined exclusively in terms of brain physiology. He gave himself to this work until his death.

Thomas McKeen based himself on the comprehensive image of the human being which can be established on the basis of Rudolf Steiner's science of the spirit, complementing the view of modem science. The more we come to understand the essential aspects of the human being, the more definite and real his actions and interaction become for us - how the interplay of physical, vegetative/living, psychic and spiritual levels of existence shapes and reshapes the human being - the more we are able to form judgments in the border area of birth and death. These changes in the configuration of the four aspects, their interaction as they unite, only to separate again, come to expression in the rhythmic repetition of human developmental stages and states of consciousness: a relationship of the four aspects that is always characteristic determines the total spiritual and physical configuration of a human being through repeated lives on earth and lives between death and rebirth. Even in an individual life on earth, the harmonious interaction is always changing. Such variations determine the stages of development known as birth, school age, maturity for life on earth, and full-age majority, the cycle of waking day-time experience, dream-filled sleep and deep sleep.

Variations take the form of unconsciousness in intoxicated states, being in a coma, under anesthesia, and ultimately of death-like sleep, the process of dying and life after death. The path of knowledge indicated by Rudolf Steiner also causes changes, based on specific laws, in the configuration of the four aspects.

When we learn to recognize these metamorphoses of incarnation and excamation and distinguish them clearly, many different degrees and qualities of dying will be revealed. These color nuances must inevitably be much more rich, complex and varied than the monotonous zero line in an EEG or the parameters of cerebral blood supply which do not assess the process of dying but merely define "brain death" legally and scientifically as a sole characteristic.

In a way this simplifies decision making - though in the individual case it may still be difficult - making technically and ethically possible what to healthy common sense must seem a paradox: to obtain live organs for transplantation from a dead body. Other areas of growing need for new insights and secure foundations for forming judgments and making responsible decisions are the increasingly urgent questions as to the justification of euthanasia, the consequences of termination of pregnancy for the unborn human being, the mother and the physician, the problems of interventions in reproductive medicine (currently the cloning of human embryos), and gene technology, an issue that is much in dispute.

End and beginning

How do we today, two years later, see the treatment of Gaby Siegel?

She gave the gift of life to her son on 26 September 1991 and died two days later. She held on here on earth and will be able to take care of her child in the spirit, as her husband put it. The father's life has taken a new direction. A computer expert, he has established a charitable organization for the treatment of people with severe brain damage. He learned to live in two worlds in that intensive care unit, surrounded by technology and spiritually united with his wife. This will be a help to him in his new work. He has spoken of the way the activity of the spiritual world in the physical world became reality for him, and he lets others share in his experiences. He is playing a role that may be called the archetypal father role: to work on external conditions of life out of a deep connection with the earth and technology at a time when his wife was already and his child still almost, in heaven. He could and wanted to achieve this only in harmony with them, receiving the strength he needed from this.

And Maximilian Matthias? A "completely normal child," as we say. He was given a tremendous task to give to his father, who in turn enrolled in the Baden-Wuerttemberg "mother and child project" to be able to care for his son. It remains to be seen what he'll make of his life and what significance the time that led up to his birth will hold for his future.

Finally, what did the Siegel family mean to us and our work? Again, we do not yet know all the consequences, above all because we ourselves are still working on them. The fruitfulness of our actions is not determined once and for all but every day anew, as we learn from experience and from our mistakes. From this point of view the critical comments of Frank Meyer and Ramon Bruell, though largely inappropriate, offer an opportunity to review the situation and clarify our thinking. Whenever we take destiny-forming actions today, the lives of those involved become part of the process. Those responsible have the power to intervene effectively as they make their decisions in complicated borderline life situations; they seek to help to the best of their knowledge but are caught up in guilt in the process. Human beings are marked by their battles with "death and the devil," they do not emerge from them as "innocent fools." They are active participants in the truest sense of the word. Outsiders, who do not accept any of the consequences, should understand that their judgments are based on a different point of view. "It is easy to give advice from a safe dis- tance" (Schiller, Wilhelm Tell).

It is in fact the awareness of this necessary "guilt" which gives growing certainty in making judgments, sharpens the eye for the essential, for genuine progress and the meaning of what we are doing. Light is thrown on the path when we recognize the immortal spirit of the human individual that Karl-Eugen Siegel spoke of, this gives meaning and - coming from the other world to take effect in this world - is "God's greatest gift" to humanity.

Michael Lamerdin, MD

Filderklinik

D-70794 Filderstadt

Germany

References
1 Siegel, Karl-Eugen. Wir durften nicht
aufgeben! (not allowed to give up). A father
describes the last months of his brain-dead
wife's pregnancy and the birth of his son.
Guetersloh: Guetersloher Verlagshaus
September 1993 (Guetersloher Taschenbuecher,
Bd974).

2 Info(3) Nr. 9/1993 (s.S. 22/15).

3 Thomas McKeen was head of the
Department of Internal Medicine and of the
Anthroposophic Medical Seminar at the
Filderklinik. He died on his 40th birthday
on 19 June 1993. At Karl-Eugen Siegel's
request, he had still been able to be with
him when he first went public, taking part
in a radio interview.