Monday, March 23, 2009

It's About the $: Libertarians Discover Futile Care Theory













I have crossed pens occasionally with Reason writer Ronald Baily and debated him (and others) at CUNY about transhumanism and other brave new world agendas. Well, Baily just [update, actually in 2006] learned about a Texas futile care case that, he writes, led to scorched earth commentary from the Left. (As regular readers of SHS know, it is legal in the Lone Star State to impose futile care upon unwilling patients.) From his column:

I somehow missed the culture war moment last month when it was reported that Baylor Regional Medical Center in Plano, Texas, disconnected a dying, uninsured cancer patient, Tirhas Habtegiris, from the ventilator that was keeping her alive. The 27-year-old abdominal cancer patient was conscious and did not wish to be disconnected because she hoped that her mother would arrive from Africa for one last visit before she died. The hospital warned the patient and her family that it would keep her on the ventilator for just 10 more days. Ms. Habtegiris died 16 minutes after the ventilator was shut off on December 14, 2005.
I hadn't heard about that one either, but I am not surprised.

Bailey says the Left was up in arms when the story became public because the cutoff seems to been motivated by money. Ya think? And he wonders why the political right didn't also jump all over the case. Perhaps they didn't know about it--as I didn't. However, if Bailey had done a little digging, he would have learned that pro lifers and others on the right have coalesced with disability rights leaders and others on the left to oppose futile care theory wherever it rears its ugly head. Indeed, this strange political bedfellow coalition has stopped the advance of Idaho's S. 1114, a bill that would legalize Texas-style futile care theory.

Meanwhile, Baily exhibits his usual terminal nonjudgmentalism about such moral issues, but notes that the issue of futile care is definitely about money:

Critics of Baylor's decision should also bear in mind that it's not as though Habtegiris did not receive medical care. She was admitted to one of the finest hospitals in America, which did treat her illness. We know that she was in intensive care at the hospital for at least 10 days and probably more. A recent study of intensive care using a ventilator calculated the cost at $2,255 to $3,040 per day, so her stay at Baylor cost the hospital at least $22,550. That's $22,550 that someone else's insurance or taxes will have to cover through increased costs....

Perhaps it was wrong for Baylor to pull the plug in this instance, but it is clear that in the real world of limited medical resources that the "authorities," whether private or governmental, will unavoidably be making similar life and death decisions in the future.

Maybe resistance is futile. But then again, maybe not: If we can alert the public to this danger, we may be able to prevent the agenda from sinking into the bedrock of medical ethics and economics.

Update: I didn't notice that Bailey's article is from 2006. It doesn't change the thrust of the post, but we strive to be accurate. Thanks, and sorry for any inconvenience caused to any SHSer.

Labels:

18 Comments:

At March 23, 2009 , Blogger SAFEpres said...

Oh, my God. I had no idea about this. I feel awful. I try to keep track of all thee cases on my website and write letters of protest (not that I personally can stop it, but you know what I mean.) Is there any other information about it?

 
At March 23, 2009 , Blogger Wesley J. Smith said...

Bailey's comment is all I know. Perhaps there was a lawsuit and it got reported.

 
At March 23, 2009 , Blogger SAFEpres said...

I see now that this occured in 2005, not recently. I'd be interested to know more about it. It's the first case that I know of where the patient was conscience and capable of verbal communication (rather than communication via a family member or living will) and was killed anyway. Whoever did that should be prosecuted for murder, pure and simple. I can't believe Bush signed this legislation in 1999. I know that he required the authors of the bill and the NRL committee to come to a compromise, but why couldn't he just say, "No, I won't sign it until it forbids hospitals from denying care to patients, period"?

 
At March 23, 2009 , Anonymous Anonymous said...

I did a little reading on this after reading this column. The brother claims that she was fully conscious and opposed the removal of the ventilator. The hospital, however, says that she was in such pain from the cancer that she was in a narcotic-induced coma.

The brother claims that the family was not given adequate time to bring the mother from Africa. The hospital claims they offered to bring in legal help but the family refused.

Also, the law in question doesn't address ability to pay - it addresses the success of the treatment. The Futile Care Law requires the family to be invited to participate in the committee that decides to withdraw treatment. During the 10 day time frame, the hospital must help the family try to find a new care provider, and the family can file for a court order to stay the removal. While we can never assume, this is an upstanding hospital, so they more than likely followed the letter of the law.

I'm not saying that the hospital was right - I wasn't in the room and no one but those involved know EXACTLY what happened. But it seems that this incident may not be as horrid as it appears at face value. There is a certain point at which nature should take its course.

 
At March 23, 2009 , Blogger Wesley J. Smith said...

Becky: I agree, but that isn't, nor should it be, up to the hospital ethics committee.

 
At March 23, 2009 , Anonymous Anonymous said...

Sometimes, I think that's up for debate. Hospitals routinely step in when guardians aren't authorizing necessary care for patients. Should we disallow doctors from overriding a parent's decision?

Artificially extending someone's life for the family's benefit seems to fall under that category. No other facility was willing to care for her, and hospitals exist to care for people, not to keep them alive until the family decides it's time (IMO).

 
At March 23, 2009 , Blogger SAFEpres said...

Becky-I disagree. It's not up for debate. People are not philosophical issues, they are people, and deciding to live is the most intrinsic freedom they have. It sounds to me like they put her in a drug induced coma before they disconnected the ventilator-thus, she told them not to remove it before they put her into a coma and removed the ventilator against her will. It wouldn't be easy to remove a ventilator if you had a conscious person begging for his or her life-it's easier for the hospital to do to an an unconscious, defenseless person. Disgusting.

 
At March 23, 2009 , Blogger Unknown said...

At the bare minimum, a person is entitled to live for as long as they want to live. Period. Anything that controverts that, for whatever reason, can't be legal, whether it's the letter of the law or not. This was murder.

 
At March 23, 2009 , Blogger Unknown said...

"Medical resources" would not be "so limited as they are" if there were less negligence, incompetence, inefficiency, disorganization, etc., which are the result of arrogance, in the practice of medicine and in hospitals. It's a matter of attitude, not of money. When I said negligence just now, I was talking about negligence committed and its direct results, not malpractice litigation and the cost of its defense and of the awards, but those also factor into the equation -- and would not if an arrogant attitude did not prevail; there would be less negligence sans that. "Resources" and "costs" are not valid factors any more than negligence is acceptable, and they need not be factors as claimed at all.

 
At March 23, 2009 , Blogger Unknown said...

"Medical resources" would not be "so limited as they are" if there were less negligence, incompetence, inefficiency, disorganization, etc., which are the result of arrogance, in the practice of medicine and in hospitals. It's a matter of attitude, not of money. When I said negligence just now, I was talking about negligence committed and its direct results, not malpractice litigation and the cost of its defense and of the awards, but those also factor into the equation -- and would not if an arrogant attitude did not prevail; there would be less negligence sans that. "Resources" and "costs" are not valid factors any more than negligence is acceptable, and they need not be factors as claimed at all.

 
At March 23, 2009 , Blogger Unknown said...

I still can't believe that Texas of all places went futile-care. And to think that I had been planning to move there. No more. Virginia seems to be on the juggernaut, too; another place that had seemed to be sane. I just don't understand it. Why those states? What happened to them? How?

 
At March 23, 2009 , Blogger Unknown said...

Wesley: From what I've seen, the agenda is embedded in that bedrock already.

 
At March 24, 2009 , Blogger SAFEpres said...

I'm confused about that too, Ianthe, particularly since a lot of the leaders there, such as Rick Perry of TX, claim to be "pro life." Although, Virginia's governor, Time Kaine, is a pro choice Democrat. I have absolutely no respect for either of them and told the campaigns of Obama and McCain that I would not vote for them if they selected Kaine (Obama) or Perry(McCain) as a running mate. Futile care violates basic pro life and pro-choice principles. It's disgusting.

 
At March 24, 2009 , Blogger JacqueFromTexas said...

Baylor is the home of Dr. Fine- and TADA is his baby. I implore you all to read the transcripts of the Texas State House debates in 2007 of Dr. Fine sabotaging transfers.

 
At March 24, 2009 , Anonymous Anonymous said...

lanthe, I agree. A person should not be forcibly removed from a ventilator. I don't think there's be any argument about that.

My indecision with this case comes from the wildly varying reports from each side. The hospital states that she was in a narcotic induced coma from Day 1 (of 25), while the brother claims she was pleading for her life as she suffocated to death.

Obviously, if it was the latter, what they did was reprehensible.

Should the case truly be the former, though, I feel it's important to remember that doctors exist to care for the patient. Doctors often must override the decisions of the family, especially when that decision is based solely upon emotions. The fact that we allow it in life - by giving doctors the ability to tell parents their child must be treated - but condemn it in death is a bit contradictory.

 
At March 25, 2009 , Blogger SAFEpres said...

What I think is that she begged for her life before they put her in the coma, so that maybe she lived for 25 days after the ventilator was shut off, but she didn't beg for her life during that time because she was made unconscious. Thus, she said no and begged them not to before they put her under and did it anyway. That's just what I think would make sense when reconcilling the two sides of the story...but I haven't read about it, so I don't know.

 
At March 26, 2009 , Blogger Unknown said...

SAFEpres: Or made what they called unconscious, and unable to move or speak but able to hear, and still aware. As for the two sides of the story, to paraphrase Ralph Kramden's buddy's line from "The Honeymooners," when someone wants to live, there is no other side.

 
At March 26, 2009 , Blogger Unknown said...

Becky: Having seen my own mother put to death by removal from ventilator after a vicious (on the hospital's part) court battle, when she was aware and wanted to live, I can't agree with you. From what I've seen, in not only that but many other scenarios, it's best I not get started on doctors, either. I'll just note that they haven't been taught logic, and often demonstrate to what great extent they lack it. Actually if doctors are able to override the family in terms of giving treatment the family does not want the patient, e.g. a child, to receive, it follows that they should be on the side of life in the other scenario, as well; it is not theirs, any more than anyone else's, to determine "better off dead" at any time, no matter what "superior knowledge" or "right" they have arrogated unto themselves and that some credit them with having.

 

Post a Comment

Subscribe to Post Comments [Atom]

<< Home