Medical Futility On the March
For years I have been warning that bioethicists are getting their ducks in a row to permit them to refuse wanted life sustaining treatment that is removed because it keeps the patient alive, not because it doesn't provide medical benefit. These are value judgments, not medical determinations.
And now they are beginning to come. I commented about a futile care case in Michigan a few days ago, and here's another. I don't know enough about the facts of this case to opine completely, but this sure seems to be a futile care case in action. St. Luke's Hospital in Houston is going to unilaterally remove a woman from life support, even though her family wants her to continue to receive care. (It is as if Michael Schiavo and the Schindlers wanted Terri's care continued but the hospital said no.)
Note that the treatment is apparently being removed because it works, not because it doesn't--which means, in effect, that the hospital ethics committee has declared the patient's life to be futile.
Texas has a terrible law that permits an unelected, self-appointed, anonymous ethics committee to forcibly remove care. Once that happens, the patient has 10 days to find another hospital. These are closed proceedings. I am unaware of any records kept of the evidence presented at the hearings or the deliberations.
These are life and death decisions and it seems to me that there may be a significant constitutional issue here of immense importance. A law permits private decision-making that will result in death without even the right to a public hearing, to cross examine witnesses, or a formal appeal. Someday, someone is going to attack this statute and its constitutional implementation frontally in federal court. I have already urged some attorneys in private that they do just that. Let us hope that fairness and simple justice prevail.


3 Comments:
The above poster's link on his name explains it all.
I would take ANY "bioethicist" with a huge grain of salt.
The 10 day period is found at Health and Safety Code 166.046(e)
"The physician and the health care facility are not obligated to provide life-sustaining treatment after the 10th day after the written decision required under Subsection (b) is provided to the patient or the person responsible for the health care decisions of the patient unless ordered to do so under Subsection (g)."
The point is that the hospital (and bioethicists who support medical futility) are imposing THEIR values on the family and patient, proving that these issues are increasingly less about "choice" and more about certain patients having no right to live based on a "quality of life" ethics.
From a physician's point of view there are a lot of medical questions about this case. However, an important point is they are talking about withdrawing treatment versus instituting new treatment. The family claims Andrea Clark is not brain damaged, not comatose, and interacts with others by moving her lips and blinking her eyes. They state she very clearly communicated "I want to live. I don't want to die." If that is true, then Ms. Clark and her family are content with maintaining this quality of life as long as possible. It seems very strange to impose an ethics committee determination that the status quo is unacceptable when the patient has indicated it is. Because of confidentiality issues we are only getting one side of the story and another side needs to be heard. However, as I have written here the hospital that has a very significant financial interest in seeing this patient dead should not be the one making these decisions.
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