Medical Futility Blog: Be Afraid, Be Very Afraid
I just learned about this blog, "Medical Futility," that tracks futility care cases. The author is a law professor named Thaddeus Pope who, from what I have seen of his entries, clearly supports Futile Care Theory.
In reading his entries, it validates my belief that the twin ideological beliefs behind Futile Care Theory are a feeling of repugnance about the lives of people with profound disabilities and a utilitarian view that maintaining their lives is, therefore, a waste of money.
In this entry, Professor Pope reports that medical students apparently believe it is wrong to sustain the lives of patients diagnosed with PVS. He doesn't comment, but based on the next entry, he no doubt approves.
Professor Pope seems to support cutting off all patients' with profound cognitive disabilities--meaning feeding tubes for those who need no other interventions--because of the cost of their care:
What does this have to do with medical futility? It permits one to perform a back-of-the-napkin calculation of the cost of inappropriate care. If it costs $250,000 to treat one PVS patient for one year, and there are around 25,000 PVS patients in the United States, then the total cost exceeds $6 billion per year--more than the entire federal portion of the SCHIP program. That is a considerable amount of money to so deplorably misspend.I happened to notice the following dollar figure in a medical malpractice case being tried in Wisconsin. The Madison County Record reports that Christina McCray was undergoing a right hand carpal tunnel surgery in 2001 when she was over-sedated by the anesthesia team, causing her to become bradycardic, hypotensive and hypoxic which caused severe and permanent brain damage. She is now in a PVS. One of McCrary's expert witnesses, Jan Klosterman, a certified life care nurse planner testified that McCrary's medical bills will average $250,000 per year--totaling $8.4 million if she lives another 30 years.
If that prospect ever became an imminent reality, I have no doubt that we wouldn't resort to mass dehydration to rid us of these useless eaters, but instead would opt for the lethal injection as more humane. Cheaper too. Now, let's see. Dehydration takes 12-14 days. The cost of the care for those days for all of the patients would amount to the tens of millions. Yup. Inject them. We have better uses for that money.
Labels: Futile Care Theory Blog
posted by Wesley J. Smith @ 9:39 AM
8 Comments
8 Comments:
Wesley,
Please allow me to make two clarifications.
(1) First, you write: "Thaddeus Pope . . .clearly supports Futile Care Theory." While I do generally support and defend the health care provider's position in futility disputes, I do NOT do so categorically. For example, my next law review article is a sustained attack on the procedural fairness of the unilateral refusal provisions in the Texas Advance Directives Act.
(2) Second, you write: "Professor Pope seems to support cutting off all patients with profound cognitive disabilities." This is most certainly NOT my position. Nothing in my blogs or law review articles suggests that I espouse such a position. I support "cutting off" ONLY those patients who are brain dead or in a PVS. Even highly distinguished disability scholars and advocates (e.g. Adrienne Asch) except PVS patients from the rest of the physically and mentally disabled.
Professor Pope: Thanks for dropping by. You prove my point. To claim that those diagnosed as PVS are not profoundly disabled--by the way an often misdiagnosed condition--is ludicrous and simply a way out of the harshness of the position. It is to dehumanize our brothers and sisters and push them out of the human condition.
Be that as it may: You certainly do advocate the mass dehydration of 25,000 patients you identifed as PVS on your blog site. That seems inescapable to me. And it is abhorent.
In this cornaaaaaah, weighing in at 79,500 silver hairs (no, they're not grey), is our reigning cham-peen, Wesley J. Smith!
And in this conaaaaaah, weiging in at having a rockin' name that is undervalued (nobody names their kids Byron, Emily, or Humphry anymore and it's a national tragedy!), the contendaaaaah, Thaddeus Mason Pope!
Here's the bell for round one - DING!
Thaddeus Pope - you don't categorically support dehydration of people diagnosed as PVS; would you support dehydrating a person diagnosed PVS if his or her family wanted continued care, or would you support the family in this case?
Wesley Smith - It is clear that you both support preserving the life of a person diagnosed with PVS and disapprove of a national health care system; how should the matter of cost of care be handled, then, in cases where the family, who wants continued care, are not amongst those who can outright afford to pay for expensive services?
For the record, I'm pretending I don't have any personal beliefs about anything right now 'cause I got into the whole boxing/wrestling ring idea from watching too many Bugs Bunny cartoons today.
"And, the challenger... Ravishing Ronald, a de-natured boy!"
...I am embarassed to say, I still don't have a clue what the hell that means, but it's funny just to hear it when you're watching a cartoon wrestler getting spritzed with perfume.
Wesley: I agree with both your points -- to an extent.
(1) First, I AGREE that failing to provide life-sustaining treatment to PVS patients is to treat them as though they are "out of the human condition." But I DISAGREE that it is to "dehumanize" or "push them" out. Dehumanization is already a consequence of their condition.
(2) Second, I AGREE that PVS patients should be allowed life-sustaining medical treatment if they can (and many do) find a provider to provide it. I certainly do not advocate the "mass dehydration" of PVS patients. Futility disputes occur when surrogate decision makers ask physicians to provide health care that the physician thinks is inappropriate. If the surrogate and the physician agree on the treatment (e.g. ANH for a PVS patient), then I would not interfere with that. I simply DISAGREE that an individual provider who considers treatment of a PVS patient inappropriate must continue to treat that patient.
"Futility disputes occur when surrogate decision makers ask physicians to provide health care that the physician thinks is inappropriate."
This is not true if taken to mean that such disputes occur "only when..." etc. Disputes can, and sometimes (often?) do, occur among family members where either "side" can easily find a physician to agree with its desired approach.
If a PVS patient is poor and uninsured, his or her care should be paid for by Medicaid or Medicare. That is how it is for any other serious health condition for uninsured poor people and it is how they should be treated, too. In other words, I don't see them any differently than any other patient.
I think the crux of Thaddeus Pope's position regarding PVS is summarized by his statement "Dehumanization is already a consequence of their condition."
That is patients with PVS, a state that many physicians disagree widely over and which we know very little about, are no longer HUMAN.
This is truly very frightening.
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