The UK continues to provide us with a vivid and terrifying education about the dangers of health care rationing. The UK”s central planners have urged that doctors make no efforts to save prematurely born babies under 22 weeks. This don’t treat decree (because that is what “guidelines” become in practice) is based on evidence measuring overall outcomes. Almost all such babies either die or have very serious disabilities (or to put it bluntly, if they live, their lives are deemed not worth living).
What this means, is that members of categories are not treated like individuals and rendered care in certain circumstances based on their individual situation. This seems to have happened to a baby born a few days before the cutoff date and, hence, allowed to just die. From the story “Doctors Told Me It Was Against the Rules to Save My Premature Baby:”
Doctors left a premature baby to die because he was born two days too early, his devastated mother claimed yesterday. Sarah Capewell begged them to save her tiny son, who was born just 21 weeks and five days into her pregnancy - almost four months early. They ignored her pleas and allegedly told her they were following national guidelines that babies born before 22 weeks should not be given medical treatment. Miss Capewell, 23, said doctors refused to even see her son Jayden, who lived for almost two hours without any medical support. She said he was breathing unaided, had a strong heartbeat and was even moving his arms and legs, but medics refused to admit him to a special care baby unit.
If that is true, it is a profound abandonment. Moreover, it illustrates the consequences of treating individuals as mere category members for treatment decisions. For example, in the UK, an older person will be denied a hip replacement based on age, regardless of whether the surgery would benefit the patient and restore the ability to live a vital life.
Some will say the baby wouldn’t have lived. Even if that is very probable–very little in medicine is certain–that’s not the point. Centralized bureaucratic boards such as the UK’s NICE–which Tom Daschle, who the NYT called the most influential person in the current health care debate, wants us to emulate–means the end of medicine as a profession, and of Hippocratic values as the guiding ethic of health care. And don’t forget, under Obamacare these centralized boards would establish the rules of care for both private and publicly funded care.
When doctors abide by bureaucratic rules in deciding the treatment to offer or withhold from patients, rather than treat patients as individuals, oppression and neglect will invariably follow. (Here’s another UK case, a stroke patient purportedly forced onto the Liverpool Care Pathway and sedated and denied fluids.) Health care rationing isn’t about what is rationed–Obama’s dumb red pill versus blue pill metaphor–it is about who is rationed. This is precisely what the majority of the American people are trying to prevent as we resist the imposition of utilitarian medical ethics under Obamacare.
September 12th, 2009 | 1:21 pm
The fact that the child lived for that long without support should immediately have called into question the prediction that he would die even with breathing support. In fact, it could even have called the gestational age into question. Every mother knows that estimates of the date of conception and due date are just that–estimates. _Of course_ the baby could have been conceived several days earlier than what had been estimated and written on her chart. This makes it doubly wrong–medically idiotic, among other things–to ignore the evidence before their very eyes of the child’s stage of development. By the way, the story mentions that they told her her baby was a “fetus.” This is also idiotic, from medical personnel. By definition, a fetus is unborn.
September 12th, 2009 | 7:20 pm
A question please:
Suppose your child has a terminal illness, and we can prolong his life for twenty-four hours, at a cost of one quadrillion dollars.
Should we do it? Yes or no?
If we don’t do it, is that what you call “rationing”? Yes or no?
September 12th, 2009 | 7:52 pm
OperationCounterstrike: Thanks for dropping by. If you ask a question with even one foot in the real world, I can answer it.
If we say that certain categories of people should not be treated based on an invidious determination that their quality of life no longer makes their life worth living or the expenses of care, of course that is rationing. And it won’t just be the “24 hours of life extension, either,” or other extreme example that pro rationers like to posit. It will be elderly people not getting hip replacements after age 70. It will be people like Barbara Wagner in Oregon refused life-extending chemotherapy but offered assisted suicide. It will be people refused feeding tubes if they become unconscious with little likelihood of returning to full cognitive capabilities–whether family likes it or not, etc.
The real world will be the UK and NICE. Do a research on this blog of “NHS Meltdown” and see the terrible consequences of utilitarian medical ethical hegemony.
Now, you answer whether we should decide to treat or not treat based on society’s or bioethicists’ views of what makes a life worth living.
And if you say yes, if you say we have the right to determine when a life is no longer sufficiently meaningful to be supported, you have tossed universal human rights over the side.
If a child is born with a likelihood of living 24 hours with full care, and that is what the parents want, we should treat. We should also educate those parents that the best course for their child is probably comfort care and be brutally honest about the potential consequences in terms of potential suffering to the child if treating to the nth degree. In such cases, most people take the better path.
But some want medical coercion. And that is the way to doom all trust in the health care system.
September 13th, 2009 | 12:35 am
“She said she was told that because she had not reached 22 weeks, she was not allowed injections to try to stop the labour, or a steroid injection to help to strengthen her baby’s lungs.”
Why wouldn’t they try to stop the labor? That part of the article got to me the most.
September 13th, 2009 | 2:02 pm
[...] deadly consequences of rationing health care Story from the Daily Mail. (H/T Secondhand Smoke via [...]
September 13th, 2009 | 8:36 pm
That is DISGUSTING. One would think that we could come up with a system that didn’t determine an abitrary “cut off” date.
[Safepres: Advise taken.]
September 14th, 2009 | 9:49 am
[...] from the Daily Mail. (H/T Secondhand Smoke via [...]
September 25th, 2009 | 5:26 pm
Seems that the UK is broadly in line with other international recommendations. From Pediatrics Journal Vol. 121 No. 1 January 2008, pp. e193-e198
“With current standards, intensive care is generally considered justifiable at 25 weeks, compassionate care at 22 weeks, and an individual approach at 23 to 24 weeks, consistent with the parents’ wishes and the infant’s clinical conditions at birth.”
So basically compassionate care = no intensive treatment, just a cuddle until the baby dies. Probably best for all concerned seeing as the outcome would be bad if it did live.
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