Janet Rivera's Cousin Granted Her Conservatorship
The family of Janet Rivera wants her to live. The doctors wanted her to die. The County Conservator sided with the doctors. He ordered her respirator and feeding tube removed. She didn't die over more than ten days. The family begged to put her feeding tube back. The powers that be refused. Finally, litigation ensued. A judge ordered the tube feeding restored. Today, a cousin got conservatorship. Hopefully that will end the case. From the story:
Janet Rivera's cousin, Suzanne Emrich of Boulder Creek in Santa Cruz County, was granted conservatorship in the high-profile case this morning. Emrich and the Fresno County Public Guardian's Office reached the deal, sealed in court. Rivera, 46, has been comatose for two years following a heart attack. It’s unclear what Rivera’s preferences about life support would be.Imagine reading this ten years ago, and it would have been unthinkable: A family begged to have their loved one's life maintained, and until a judge got involved, their pleas fell on deaf ears. And who knows the extent of harm caused by more than a week without food and water. Such is the nature of the culture of death that this way comes.
The county removed her from life support July 11 over her family’s objections. Life support was reinstated July 23.
Labels: Janet Rivera. Conservatorship.
posted by Wesley J. Smith @ 10:19 AM
7 Comments
7 Comments:
WS: "Today, a cousin got conservatorship. Hopefully that will end the case."
Unless, of course, the cousin concludes after many weeks of reflection and consultations with the patient's physicians that Ms. Rivera has in fact suffered permanent and catastrophic neurological damage and the cousin decides that the benevolent thing to do is to withdraw life support instead of sentencing her cousin to a non-sentient bedbound existence. THEN I would imagine folks like yourself will refer to this woman as a murderer and demand that she be replaced with someone whose values are more palatble to you and, thus, must be in the best interests of Ms. Rivera.
WS: "Imagine reading this ten years ago, and it would have been unthinkable: A family begged to have their loved one's life maintained, and until a judge got involved, their pleas fell on deaf ears. And who knows the extent of harm caused by more than a week without food and water. Such is the nature of the culture of death that this way comes."
You're crying wolf again, Mr. Smith. Unilateral withdrawal of life support over the wishes of a patient's surrogate is both exceedingly rare and usually anathema to hospital administrators and attorneys who prioritize the fear of negative press over the duty to provide medically appropriate end-of-life care. Contrast the number of futility cases in Texas that have emerged since the TADA's futlity provisions versus the estimated number of cases of medically inappropriate EOL treatment in a state of that size. Where's the data to support your Trojan Horse theory of the 'medical-futility-to-euthanasia' progression?
When it comes to EOL health care, we all reside on your proverbial slippery slope, and to reflexively "err on the side of life" is by admission still to err; an error that in the case of Terri Schiavo over 70% of Americans felt was morally wrong. (A whole lotta conservatives in that percentile.)
Please give the health care rationing that occurs throughout the life cycle due to poor or no insurance the same importance that you give cases of (alleged) rationing of end-of-life care for the terminally or catastrophically ill.
Crying wolf my foot. Ever hear of medical futility? It's the law in Texas and other states. Books are written about it. Blogs are written promoting it. Hospitals all over the country--we don't know how many--have adopted protocols.
We are holding it somewhat at bay through public activism, but it ain't crying wolf.
And with regard to the cousin, that could happen. But if it does, it wouldn't be a stranger insisting that Janet be made dead by dehydration over the objectios of every member of her family.
Books and blogs do not always include credible research. There is much data supporting the opposite thesis; that too many Americans are receiving unnecessary and ineffective end-of-life care. A recent example...an '08 study in the journal Oncology (2008;22, 8:881-887) reveals that over 20% of Medicare patients with cancer begin a new chemotherapy regimen within 2 weeks of death. Sounds more like a culture of death denial to me than of some insidious plot to ration care.
While many hospitals have (or are) developing policies on medical futility, relatively few of these polcies have statutory support and still fewer enjoy any real traction within their clinical setting. Futility is too hard to define and there are too many liability concerns associated with the unilateral withdrawal of life support. The main benefit of futility policies appears to be of a practical nature; namely that physicians are 're-empowered' to offer medical treatment plans according to prevailing standards of care. Even with such futility policies, patients always retain the right to seek second opinions and/or to transfer their care to another physician or facility, but they don't have the unqualified right to demand treatments that do not offer a medical benefit. Hardly a radical notion.
On the other hand, as you suggest... If we SHOULD enjoy an unqualified right to dictate what treatments we receive without regard to any evidentiary standards of medicine, then by extension, why could we not make such demands in non-end-of-life scenarios as well? Why shouldn't patients be able to demand experimental therapies or unnecessary narcotics solely on the basis that the patient or his family feels that they MAY work or that they will confer an intrinsic benefit to the patient? In other words, why should patients receive any & all requested medical care at the end of life but not enjoy this right in non-terminal care situations? What's the medical (or moral) difference?
With respect, for an well-known ethicist you don't sound like you spend much time in hospitals. I read that you are an attorney, but do you additionally serve on any hospital or hospice ethics committees or administrative boards?
I'm not meaning to antagonize or 'bait' you with my posts and I do respect the sincerity of your beliefs. I just believe that some of them are misguided.
O: You say: "While many hospitals have (or are) developing policies on medical futility, relatively few of these polcies have statutory support and still fewer enjoy any real traction within their clinical setting."
Oh, well then I feel better.
Actually, in addition to Texas that explicitly legalized futility, California has a law that would appear to do likewise, although it is more vague. Moreover, we have seen in lawsuits in Canada and elsewhere, claims made by physicians and bioethicists that futility should be allowed.
Some of us are working very hard to prevent medical futility from being permitted. We have had some success so far--even in Texas--because futility conflicts with the choice meme that has dominated bioethics for the last 20 years.
We are going to strive to revent the pivot to futility and explicit rationing--as happens under Oregon's Medicaid.
I'll ask my question again: why should patients have an unchallenged right to receive any type & level of medical care at the end of life but not enjoy this right in non-terminal care situations? What's the medical and difference? Why do we allow doctors to deny treatments on the standard-of-care basis in all other cases except at the end of life? If we can't trust doctors and health care facilities at the end of life, why should we trust their decision making in any other context?
They shouldn't. But if requested treatment is so onerous that it amounts to torture, that decision should not be made by the doctors or a star chamber bioethics committee meeting. It should be done in open court, with a record, and right of appeal. The family should be provided legal counsel by the hospital to prevent a win due to deeper pockets.
But most futility cases aren't at that level.
One Futilitarian, as I call them, said that unless they can say no, people can demand brain transplants. But that's just a way of avoiding the issue.
People should have the right to have their lives maintained if that is their desire. Otherwise, the very definition of and a primary purpose for medicine is turned on its head.
Who are you to tell someone they have to die when they want to fight for life? Assuming the life support isn't physiologically futile, it is a legitimate request and in keeping with the purposes of medicine.
And don't think it will stop with the hard cases we hear of now. I asked one futilitarian who would be next once the principle was established that bioethicists or doctors could decide which physiologically beneficial care could be denied based on their values.
He said, "marginally beneficial care." I asked for an example. He said an 80-year-old woman who wants a mammagram.
Very dangerous waters.
Bioethicists are not the high priests. Doctors are responsible for medical decisions, not value judgments.
The key to preventing most of this is candor at the bedside and education. Most people make the right decisions in that regard. But coersion will destroy the people's trust in medicine.
Why, some bioethicists even want the right to overrule advance directives. So much for autonomy.
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