Allowing people to make their own informed decisions regarding the extent of end-of-life medical treatment is crucial to respecting all people as persons. Indeed, that view was first promoted by the late great Paul Ramsey, the Christian theologian/bioethicist, in his pioneering lectures and subsequent book, The Patient as a Person.
Today, many bioethicists push to treat some patients as unpersons. One form of this assault is futile care theory–which presumes to give doctors and bioethicists the right to refuse wanted life-sustaining treatment based on their personal values–rather than those of patients and families. Most alarmingly, much advocacy for medical futility is coming from some Catholic hospitals and associations. Thus, as I criticized in the NRO–the Texas Catholic Conference opposed an attempt to revoke that state’s futile care law and the concept was vigorously promoted in the pages of Health Progress, the journal of the Catholic Health Association ( “Time For a Formalized Medical Futility Policy”).
Meanwhile, there is a futile care case in the New Jersey Supreme Court that may determine the legality imposing futile care in that state. I won’t get into the details of the case here. But let’s examine an apologia for futile care by Patricia Codey, a nun and head of the Catholic Healthcare Partnership of New Jersey, and Elizabeth Ryan, the CEO of the New Jersey Hospital Association. From their opinion column, “NJ Court Has Chance to Influence Compassionate End-of -Life Care:”
But the unprecedented science and technology available to us today cannot change one fact of life: There comes a time when death is inevitable. Science may be able to force air into a dying person’s lungs or pump nutrients into the digestive system. In short, science can prolong the dying process. But is that really what we want from our health care system?
This is classic in futile care advocacy. Rather than being described as extending life–cutting off wanted care is described as preventing an extended dying process. But some people want their lives–or the time it takes to die, if you prefer–extended in such cases. Futile care gives strangers the right to decide that even if you want to live in a terrible state, too bad, because we deem that your life is no longer a benefit to you, as the authors readily assert:
The question our society must confront is: Should health care professionals be required to use technology to prolong a dying patient’s life when those interventions violate longstanding medical ethics and standards, while providing no relief or benefit to the patient?
No, the real question is whether we want doctors/bioethicists/bean counters to say that life itself is of no benefit to the patient. Nor should we allow the medical system to devolve into a milieu in which only patient decisions for death are sacrosanct if the doctors/bioethicists/society disagree. But in more extreme cases, that is just what the authors advocate:
That’s why our organizations — the Catholic HealthCare Partnership of New Jersey and the New Jersey Hospital Association — have joined this case. Representing a faith-based organization and a secular health care association, we respect both the sanctity of life and the health care mission of healing and caring. The question our society must confront is: Should health care professionals be required to use technology to prolong a dying patient’s life when those interventions violate longstanding medical ethics and standards, while providing no relief or benefit to the patient?
It really rubs me wrong when religion (in this case, the piety of a nun and a Catholic health association)–which we are so often told should be forbidden in discussing public health policy–is pulled out of the hat as a justifyer to promote futile care theory without complaint from the usual secular bioethics crowd. I guess it just depends on whose ox is being gored. Back to the piece:
In striving for the proper balance, we must ask ourselves some key questions: How much care is the right amount of care? When do health care interventions — in the form of machinery and technology — become inhumane rather than heroic? What, in fact, is a death with dignity?…These questions are deeply personal, and that’s why we will continue to urge all individuals to state their end-of-life wishes through an advance directive or a health care proxy. But these very personal decisions are now becoming a societal issue as well — one that will confront physicians and families again and again in the years to come.
That’s not their decision, so long as the requested intervention is not physiologically futile and is a legitimate medical act. Moreover, futile care theory would permit hospitals to overrule patient’s advance directives, which we have been told for years should rule health care decision making.
I understand the arguments on the other side. But can we please stop pretending that futile care is about doing patients and their families with heterodox end-of-life views a favor? Coercion–because that is what we are talking about here–is not going to make the patient’s deaths go down any easier with the expression of such compassionate sentiments. Nor will futile care theory–and its even tougher older brother health care rationing–improve the public’s fraying faith and trust in the health care system overall.
May 30th, 2010 | 6:20 pm
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May 30th, 2010 | 8:15 pm
I can’t help but notice that which way to follow changes from case to case, depending on which one will justify death. It seems these people are committed to death. All out of compassion of course. The hypocracy makes me sick. Why don’t they just admit they want the right to kill?
May 31st, 2010 | 2:18 am
Going by the media, you’d think all nuns are anti-thetical to the beliefs of the Catholic Church…we live in a very strange, very disturbing age.
Also: do you guys know you’re running ads for Ashely Madison?? I’m not really sure that First Things wants to be running ads that encourage people to have affairs!
Here’s a screen cap:
http://tinyurl.com/32j2ngn
June 1st, 2010 | 5:03 am
Bioethicists Should Stop Pretending…
It truly is hard to ignore the argument that people really should be able to decide what is best for their body and life. This also holds true to ending it, according to those that believe informed and personal decisions are the best without. . …….
June 1st, 2010 | 10:03 pm
Where is the coercion in this case? To demand that doctors and hospitals provide medical care they deem unethical is to force them to violate their own consciences. If it is legal for the patient to refuse medical care at a certain point, it ought to be legal for a doctor or hospital to refuse.
People have a right to seek medical care, and doctors have a right to provide it, but neither has the right to force the other. The responsibility of doctors to care for their patients cannot be severed from their own judgment of what is in the best interest of the patient, except in those circumstances where the liberty of the patient is also curtailed.
Wesley J. Smith Reply:
June 1st, 2010 at 10:17 pm
No, Philip. That would allow homophobic doctors to refuse to treat AIDS patients who were gay. This is a very complex and important issue. No doctor should be allowed to save a life because he or she doesn’t think that life is worth living. Once a doctor has assumed the care of a patient, he or she may not abandon that patient. That is basic professionalism.
I support physician conscience in cases where doctors are being asked to take a life. But not when they are being asked to save a life.
June 3rd, 2010 | 8:36 am
“But the unprecedented science and technology available to us today cannot change one fact of life: There comes a time when death is inevitable. Science may be able to force air into a dying person’s lungs or pump nutrients into the digestive system. In short, science can prolong the dying process. But is that really what we want from our health care system?”
I don’t think it is. Consider this scenario: a patient is scheduled to undergo a life-saving organ transplant. A day or two before the procedure is to take place he accidentally falls into his swimming pool (or slips in his bath tub, or whatever) and nearly drowns. As a result of oxygen deprivation he sustains severe brain damage and enters an irreversible state from which recovery is impossible.
Let’s also say, for purposes of discussion, that the procedure could be performed with only its usual risks to the patient’s life, and without causing any further deterioration to his general physical condition.
Should we, or shouldn’t we (and why why/not):
(a) Go ahead and perform the transplant, thus curing the patient but ensuring that he’ll remain in a coma for a considerably longer period than otherwise?
(b) Skip the transplant, move on to the next person on the organ replacement waiting list and, as for the patient, let nature take its course?
(c) Pull the plug, and make it possible for the patient’s other organs to be used (assuming, of course, that he had already volunteered to be an organ donor)?
(d) Do something else, such as __________ ?
PLEASE, no “it’s too remote a possibility” stuff. I’m really interested to see what choice people will make, and why.
June 5th, 2010 | 11:33 am
I thought the point was that there is a difference between saving a life, and using technology to extend the life without any hope of a general physical recovery. The flip side of this “saving” is that it can merely preserve the person’s life long enough for the digestive tract to fail, and the body will quickly starve, and what: continue saving the life: jump start the heart, put two people on the job at all times, one hand pumping the heart, the other the lungs, while…. For goodness sake. I don’t know why the family would choose this, unless they are just upset the boy had died of AIDS, and felt the body must be further punished to save the soul.
Wesley J. Smith Reply:
June 5th, 2010 at 2:00 pm
Why should no hope of a physical recovery mean anything, Philip? Are we only worthwhile if we can lead a vigorous life? Perhaps they know that is what the boy would want? I dont’ know. I almost certainly wouldn’t make the same choice. But it isn’t my life or my child. So, who are we to tell them to do otherwise because we disagree?
June 5th, 2010 | 10:04 pm
Wesley: You misstate the question. It’s not a matter of whether WE are worthwhile because of the character of our lives. The question really is whether life itself is worthwhile if it must be lived blind, deaf and insensate without any chance of improvement. I find it hard to reconcile your theory that humanity is “exceptional” because it is capable of making moral judgments, with the argument that a member of the species homo sapiens is “human” even if he or she is in effect no more than an insensate conglomeration of cells.
In anticipation of the counter-argument: NO, an automobile ceases to be an automobile when it’s completely wrecked beyond the ability to ever fulfill its defining function(s). It is then called “a wreck, or scrap or salvage.
June 6th, 2010 | 11:15 am
Wesley,
I might be off-base on death being imminent even with the life support. By general recovery, I meant more stabilization of other vital functions. I don’t think the question is what kind of life is worth living, but whether it is necessary or proper to sustain life while the body is deteriorating rapidly (days to weeks left) in every function.
I really don’t see how doctors and hospitals can be forced to act in a case that would not be some form of negligent manslaughter or homicide if they do not act, so that the family would have no choice in the matter either.
Wesley J. Smith Reply:
June 6th, 2010 at 6:40 pm
Thanks for the clarification, Philip. I think what is needed in these cases is brutal honesty. Example: Grandma has metastatic cancer throughout her body and weighs 80 pounds. The family asks for CPR. It seems to me that the doctors should tell the family that if they do it, it almost surely won’t work and could well break her ribs. Most people make the right decisions.
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