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Filing Lawsuit Stops Hospital From Imposing Futile Care Treatment Cutoff Against Infant
Tuesday, November 24, 2009, 12:44 AM
Wesley J. Smith

An attorney affiliated with the Alliance Defense Fund has used litigation to stop a Tennessee hospital from unilaterally withdrawing life support from an infant.  From the story:

East Tennessee Children’s Hospital said it would continue caring for 9-month-old Gabriel Palmer from Sweetwater. The attorney for Catherine Palmer, the baby’s mother, said Gabriel was born prematurely. He was diagnosed with a rare disease that family members said is affecting the growth of his wind pipe.

In court papers filed Monday, the family’s attorney said Children’s considered Gabriel’s care futile.  He said an agreement has been made with the hospital and believes his client’s complaint will eventually be dropped. “I filed a complaint today seeking a temporary restraining order to make sure no care is withdrawn from the child,” said Knoxville attorney John Threadgill, who represents the Palmer family. In the complaint, Threadgill claims a Children’s official told Gabriel’s mother “ETCH was going to cease Gabriel’s respirator, medications, pulse oximeter and milk feeding because they considered his care futile.” The complaint goes on to read that the mother said the staff member told her that a committee of doctors “would meet soon to make the formal decision of withdrawal of treatment, but that the decision was a foregone conclusion.”

The complaint states “Gabriel Palmer’s condition is stable.  He is not dying, and he could live for many years.” Threadgill pulled the restraining order request from Monday’s court docket after attending a meeting a ETCH. “There was an ethics committee meeting of the hospital where they were to decide the future care of the child,” Threadgill said.  “The decision was made that the child will remain a patient at least for now at the Children’s Hospital.”

That’s how it is done!

This is why laws that give ethics committees the power to refuse wanted life-sustaining treatment–like the one in Texas–must be fought tooth and tong. If extending life, when that is what the patient or parent wants, ceases to be a fundamental purpose of medicine, if the values of doctors or an ethics committee can trump those of patients and families, none of us is safe.


Reason Not to Dehydrate: Man Speaking After 23 Years in Locked-In State
Monday, November 23, 2009, 10:57 AM
Wesley J. Smith

We hear constantly that people diagnosed as being persistently unconscious should be dehydrated to death because they are not “persons,” or are actually “dead”–and so should be available for organ harvesting.  We hear that even if the family resists, futile care theory should permit bioethics committees to impose unilateral withdrawal.  And we hear this even as repeated studies demonstrate that 40 or more percent of patients diagnosed as PVS really aren’t.

But the dehydrating lobby merely reply, “That’s even more reason to do it! Imagine the suffering!” Well, imagine you are in the locked in state (awake and aware but unable to communicate) and hear doctors telling your family to kill you.  Now that is terror.

But there are abundant reasons to treat people with profound cognitive disabilities as fully human beings.  First and foremost, because they are us. Second, because we don’t know enough about how the brain works to know that there won’t be some regeneration to permit eventual restoration of some function.  But also, because there is always hope.

Case in point: We hear from time-to-time, for example, that a person in PVS awakened.  And now in Belgium [NOTE, this corrects original post that incorrectly stated this happened in the UK], a  man misdiagnosed as unconscious for 23 years is now telling how he was fully aware all along.  From the story:

A car crash victim has spoken of the horror he endured for 23 years after he was misdiagnosed as being in a coma when he was conscious the whole time. Rom Houben, trapped in his paralysed body after a car crash, described his real-life nightmare as he screamed to doctors that he could hear them – but could make no sound. ‘I screamed, but there was nothing to hear,’ said Mr Houben, now 46, who doctors thought was in a persistent vegatative state. ‘I dreamed myself away,’ he added, tapping his tale out with the aid of a computer.

Doctors used a range of coma tests before reluctantly concluding that his consciousness was ‘extinct’. But three years ago, new hi-tech scans showed his brain was still functioning almost completely normally. Mr Houben described the moment as ‘my second birth’. Therapy has since allowed him to tap out messages on a computer screen.

Houben is here today only because he wasn’t dehydrated to death.  There is no doubt he went through a horrendous experience, but thanks to treating him as a fully equal human being by caring for him all those years and giving him tests late into his disability–explicitly refused to Terri Schiavo–he is here today to tell tale and live the rest of his life.

And for goodness sake, whatever you believe about these issues, don’t talk in the presence of PVS or other apparently unconscious patients as if they aren’t there. Rather, always treat such people as if they can hear you, because sometimes they can.


Obamacare: Government Funded Studies Pushing Toward Futile Care Rationing?
Friday, October 16, 2009, 7:57 PM
Wesley J. Smith

I have been warning for nearly ten years that the Medical and Bioethics Intelligentsia were committed to imposing futile care theory on the most weak and vulnerable patients.  Lately, we have been discussing the pronounced threat of health care rationing under Obamacare.  Today, I noticed two new studies in the New England Journal of Medicine that could be abused by health care rationing and medical futility advocates to justify policies that prevent certain patients from receiving wanted life-extending treatment.

One deals with late stage dementia as a terminal illness, and the other with providing kidney dialysis for the frail elderly. Both suggest that a better way to go for the wellbeing of the patient may be to switch from life-extending treatment for these patients to a hospice-style palliative care approach. From the story:

A surprising number of frail, elderly Americans in nursing homes are suffering from futile care at the end of their lives, two new federally funded studies reveal. One found that putting nursing home residents with failing kidneys on dialysis didn’t improve their quality of life and may even push them into further decline. The other showed many with advanced dementia will die within six months and perhaps should have hospice care instead of aggressive treatment. Medical experts say the new research emphasizes the need for doctors, caregivers and families to consider making the feeble elderly who are near death comfortable rather than treating them as if a cure were possible — more like the palliative care given to terminally ill cancer patients.

“Consider”-yes.  Impose, no.

The palliative option should always be an option for patients nearing the end of their lives.  But the final decision should ultimately be that of  the patient/ family/surrogate–(assuming a patient is not forced off food and fluids based on quality of life judgmentalism).  There comes a time when nature should be allowed to take its course and people have the right to refuse unwanted interventions. They, have the right–not bureaucrats or bioethicists.

But: If these and other studies are used by cost/benefit/best practices bureaucrats to coerce decisions or require that these patients not be maintained, that is a different matter altogether.  It is the difference between a patient treated as an individual, and a patient treated as the member of a category, the latter 0f which profoundly endangers the elderly and people with disabilities–as the as recent horror stories out of the UK about the Liverpool Care Pathway vividly illustrate.  And I fear, based on the italicized language above, that forcing patients off of wanted treatment is precisely how the Obamacare bureaucrats would use studies such as these.  Indeed, the noxious notion that if there is no cure, there is no point to maintaining lives, is growing among the usual suspects.  Indeed, there is an attempt within these circles to deny that life itself is  a benefit–even when those most affected want it to continue–that, hence, the time comes when we can put a patient out of society’s misery.

This is not to say, of course, that these studies should not be done.  Assuming they don’t have secret agendas, they should be conducted and discussed to help professionals know likely outcomes when discussing options with patients and families. But they should not be abused to create policies that take away treatment options and victimize the most weak and marginalized among us.


Obamacare Roadmap: Under “Healthcare Reform” Will We Still Get to Decide About End-of-Life Care?
Tuesday, July 7, 2009, 12:39 PM
Wesley J. Smith

There is much advocacy around the issue of cost containment as we enter the great debate over health care “reform.”  Here is the gig that seems to be developing:

  • We have to cut costs.
  • People having their lives extended when they can’t be “healed” cost too much.
  • They should choose hospice or refuse treatment.
  • If they won’t make the right choice, it is now often hinted (while not stated explicitly), we will.

An article called “Reform Health Care Now: End of Life Costs are Too High”, by Russell Kirk, MD, seems to follow that road map. From the article:

This same scenario is played out again and again: A situation is more or less hopeless but gets dragged out for weeks, months and sometimes years. It seems as though the patient’s quality of life takes a backseat to treating the problem at hand. More to the point, most family members don’t consider the staggering costs of end-of-life care since Medicare covers many people who end up in this situation. In a report issued in April, Dartmouth researchers found that total Medicare spending in the last two years of life ranges from an average of $53,432 for patients treated at the Mayo Clinic in Minnesota to $93,842 for those at the U.C.L.A. Medical Center in Los Angeles.

What’s the alternative? No clear answer has emerged, but almost everyone agrees that we have to figure out how to manage end-of-life care in a more cost-effective way as the baby boomers age. And we need to distinguish between care that prolongs life and care that actually heals the sick. For example, one option for cancer patients when it’s clear the disease is terminal is to utilize hospice care.

I am all for hospice care and refusing unwanted ICU–if that is what the patient wants. As long time readers know, I have been a hospice volunteer.  My dad died of colon cancer receiving hospice as have other relatives and very close friends.  But here’s the thing: Once we say that a life is not worth preserving based on costs, we have instituted explicit rationing and created a duty to die.

The doctor then talks about a “well thought out plan” for end of life care and the signing of advance directives.  Again, I’m all for it, but recall that there are many forces wanting to give faceless bioethics committees the right to veto your desires–even if set in writing.  I suspect the good doctor would, too.

One final point: This article was linked and promoted at the assisted suicide advocacy group Compassion and Choices, and that set off alarm bells. Assisted suicide is the elephant in the living room of health care reform that Kirk ignored. But the fact that C and C lauded the article means that the money issue is coming to the fore in assisted suicide advocacy, just as I always predicted it would.  I mean think of all the money to be saved if instead of hospice or an extended time of debilitation we could give the patient a lethal jab or a poison brew! Indeed, it’s already happening: Recall, in Oregon, Medicaid has refused life-extending treatment to cancer patients but explicitly offered to pay for assisted suicide.    Not that assisted suicide will become the cornerstone of health care reform. But make no mistake: It is the monster lurking in the shadows that we ignore at all our peril.

So, here’s the gig as I see it developing: In the new health care order, “choice” will be sacrosanct if the choice is death–either naturally or by lethal means. But if the choice is is to go on living–at a certain point “choice” will cease to be operative because you will have become unwanted ballast. Eventually, that could even mean non voluntary euthanasia as now occurs with regularity in the Netherlands.


The Left Begins to “Get” The Threat of Futile Care Theory: Mickey Kaus Wants To Decide For Himself
Sunday, June 21, 2009, 1:39 AM
Wesley J. Smith

It’s about time: Other than the disability rights movement and Nat Hentoff, it seems to me that the Left has been not only supine in the face of the oncoming “duty to die,” but its enablers.  Maybe the worm is beginning to turn. Mickey Kaus at Slate believes–silly man—that he should have a right to live.  From his blog:

I want to make the decision to cut off treatment, not have it made by a cost-watching health board. Choice! The resonance with the abortion debate seems obvious. … Both are life/death decisions. Are they both best handled by individuals and their families in consultation with their doctors? You’d think the case for “choice” at the end of life might be stronger, since the life at stake is likely to be able to participate in making that choice. …

Update: Prof. Althouse distinguishes this kind of choice from “right to die” cases. “It’s one thing to deny the choice to die, quite another to deny the choice to live.”

Health care rationing and Futile Care Theory about taking away that very choice. As the post points out if someone doesn’t want life-sustaining treatment, more power to them. But utilitarian bioethics boards shouldn’t be able to force that “choice” upon us.

I have always believed the medical futility debate is extremely winnable because for once the “choice” soundbite cuts against the culture of death.