For ethicist, end-of-life debates turn personal
Peggy Fletcher Stack, Salt Lake Tribune
June 04, 2009

For ethicist, end-of-life debates turn personal

For ethicist, end-of-life debates turn personal
Peggy Fletcher Stack, Salt Lake Tribune
June 04, 2009

SALT LAKE CITY — The moment Brooke Hopkins’ heart stopped beating, Peggy Battin found herself in a scene whose ending she had written time and again.

Doctors, nurses and aides swarmed Hopkins’ hospital bed, urgently working to save his life. Battin watched in horror as his eyes rolled back and his face grew ashen. A burly aide screamed at her to get out, but she didn’t budge. She couldn’t leave her husband of more than 20 years. Not now. Not ever.

“Oh, my God,” she thought. “This could be it.”

It was a time of decision and pain that Battin had described often through decades of studying the issue of death. Beginning in the 1970s, she was a pioneer in the field of medical ethics, specializing in end-of-life questions.

Suicide. Euthanasia. Do Not Resuscitate orders. When and how to die.

These were the knotty subjects she debated and discussed in the classroom and courtroom. Yet it was always about other cases, other people, other situations.

In one unexpected episode on an ordinary November weekday, Battin’s personal and professional lives collided.

RNS photo by Leah Hogsten/The Salt Lake Tribune

Peggy Battin, a bioethicist at the University of Utah, conducts physical therapy on her husband, Brooke Hopkins, who was paralyzed in a bicycle accident.

She knew by heart the arguments for not resuscitating fatally injured patients. She had defended vigorously a person’s right to be the final architect of his own death. Yet she also knew her husband well enough to believe he would want to live even if completely paralyzed.

But what if he hadn’t? Could she have signed a do-not-resuscitate order?

Or worse, if he asked her to help him end his life, could she have done it?

Hopkins’ life-altering accident last November, Battin says, “has presented me more than an intellectual challenge to the views I’ve been defending over the years. It is a deeply personal, profoundly self-confronting


Her son, Michael Battin, has witnessed his mother’s metamorphosis.

“Not a single part of her world is the same as it was six months ago,” he says. “It is the most fantastic irony you could imagine.”


On that fall morning, 67-year-old Hopkins had just finished teaching a Mark Twain class and set out about noon for a bike ride up the Salt Lake City canyon. Battin had a cold, so she opted to attend a couple of philosophy lectures and work in her office.

When she couldn’t reach her husband on his cell phone by 5 p.m., she had a fleeting sense of foreboding but dismissed it. When she drove up to their home and saw a police officer talking with her neighbors, she knew something bad had happened.

Hopkins had collided with another cyclist riding up the canyon as he was coming down. Hopkins, wearing a helmet, was thrown off his bike and landed facedown on the side of the road. The other man’s bike was destroyed, but he was not injured.

After passersby administered CPR, Hopkins was taken to the hospital under the name “Trauma Denali,” given to all unknown patients. When Battin arrived at the hospital, she saw the beautiful body she had loved lying utterly motionless, like Michelangelo’s “Pieta.”

She called her family with the news: her husband’s neck was broken.

He was paralyzed from the neck down.


Four decades earlier, it was another family crisis that prompted Battin’s lifelong interest in end-of-life care.

Her parents, both professionals with doctorates from Columbia, raised their two daughters to focus on their minds, not their bodies.

Young Peggy was programmed from birth to ask questions, to consider the pros and cons of every situation. “She had a philosophical, intellectual approach to everything,” said her younger sister, Sally Hogenauer, of Long Island, N.Y. “You don’t get things done that way. You just talk about them.”

When Peggy was 20 and Sally 18, cancer struck their mother. Battin remembers her mother taking agonizing steps from her bed to the bathroom, sitting down midway and moaning, “Why does it have to be so hard to die?”

Their mother’s death propelled both girls into their futures:

Hogenauer became a hospice nurse and bereavement counselor. Battin took a more cerebral path, exploring an individual’s right to say when enough is enough.

Battin landed in Utah in 1975, where she met Hopkins when they were assigned to teach the required class Intellectual Traditions of the West. He was a handsome, lanky outdoor enthusiast and gourmet cook. She was a fair-haired, rigorous thinker, questioning every assumption, always arguing the opposing point of view.

“We had a ferocious discussion,” Battin says of their first exchange, “then lunch. The rest is, of course, an extraordinary history.”

Over time, Battin became a key figure in the emerging national field of bioethics. She cranked out essays, compiled collections and edited volumes on death and medicine. Soon she was known for such titles as “The Least Worst Death,” “Ethical Issues in Suicide” and, more recently, “Ending Life: Ethics and the Way We Die.”

Still, her approach was intellectual, not personal. Her daughter, Sara Battin Pearson, says she knew where her mother stood on every issue and why, but “just because she defended a person’s choice for physician-assisted suicide didn’t mean that’s the choice she would make for me or my family.”


As she paced the hospital halls, Battin had to figure out how she was going to stitch together a new life with Hopkins. What parts of her career could she hold onto? How would she manage all the new information, deal with doctors, run the household and meet her husband’s emotional needs?

She knew she also had to tend to herself. She would disappear for hours at a time, hiking through the hills. Pearson has come to realize that her mother’s walks, work and other diversions have kept her mother grounded.

“I am so impressed with her ability to take this as a new way of life,” Pearson says. “She’s lonely in the house. She misses him, but she deals with it and keeps going in her own way and in her own world.”

Battin’s sister also sees a new Peggy — gentler, more aware of real life. “There is no question that this is transforming her,” Hogenauer says. “It is humanizing her on many levels.”

Hopkins sees the changes, too.

“Peggy has become more herself through this,” he says through the ventilator in his breathy baritone. “She has always asked questions, now just asks more of them, and some that other medical people often don’t even think about.”

Sometimes Hopkins’ accident seemed to undercut everything Battin thought about medical ethics. A medical student told her recently, “You’d never want to be on a respirator or with a feeding tube.” Battin thought about how those very devices, however invasive, had saved her husband’s life.

“I felt a distance from these conversations,” she says. “I see a lot of things in a more close-to-the-ground way than I did.”

Unlike many patients with spinal-cord injuries, Hopkins says he has never wanted to end his life, even in his darkest moments.

But what if he told Battin he couldn’t go on?

“You can’t imagine anything more intensely personal, because I love this person,” she says, her voice cracking, tears in her eyes. “But there are two components to love — love is partly wanting to be with him, but it’s also wanting what’s best for him and wanting to want what he wants. What he wants and needs might be different from my self-interests.”

In time, Battin’s perspective may change and expand in unanticipated ways. She and Hopkins are documenting the experience on a joint blog and plan to write a book.

“We have cried a lot together, and that is very therapeutic,” Hopkins says. “We have had to go back and forth and refine

our ideas, retelling the story to one another, and that brings people closer together.”

Many relationships fall apart under these conditions, he says. “But our love has deepened and deepened and deepened.”


NOTE — Stack writes for The Salt Lake Tribune.)