This is a great story of democratic governance. Awhile ago, I was informed that Idaho was poised to pass a bill explicitly permitting futile care impositions based on quality of life. It had passed one house unanimously under the radar as part of a larger bill, much of which was totally unobjectionable, dealing with advance directives and the like. But once Idaho activists discovered that the legislation would permit doctors and hospitals to unilaterally withdraw wanted life-sustaining treatment, they stopped the bill in its tracks.
But there were still good things in the larger bill that were worth passing, and now it is back—only this time instead of permitting medical discrimination based on quality of life, the bill forbids it.
First, the bill would prevent the withdrawal of food and fluids when a surrogate or patient wants it provided. From SB 1348:
Assisted feeding or artificial nutrition and hydration may not be denied if, in reasonable medical judgment, its denial would hasten or result in the death of the patient and if its provision is directed by a competent patient in accordance with section 39-4503, Idaho Code, by a patient’s health care directive under section 39-4510, Idaho Code, or by a patient’s surrogate decision maker in accordance with section 39-4504, Idaho Code.
Excellent. It then outlaws imposing futile care withdrawals based on quality of life judgmentalism:
Health care whose denial, 16 in reasonable medical judgment, would hasten or result in the death of the patient, and that is directed by a competent patient in accordance with section 39-4503, Idaho Code, by a patient’s health care directive under section 39-4510, Idaho Code, or by a patient’s surrogate decision maker in accordance with section 39-4504, Idaho Code, may not be denied:(a) On the basis of a view that treats extending the life of an elderly, disabled or terminally ill individual as of lower value than extending the life of an individual who is younger, nondisabled or not terminally ill; or
(b) On the basis of the health care provider’s disagreement with how the patient or individual authorized to act on the patient’s behalf values the trade-off between extending the length of the patient’s life and the risk of disability.
Splendid. The real tragedy is that such a medical anti discrimination law is necessary. But the utilitarian tendencies within American medicine are increasing and must be countered. I hope these provisions pass quickly into law and serve as models for other states.
