Futile Care Laws: Anti Choice, Anti Life


Despite the polarization that often occurs between the pro life and pro choice camps, there are many issues upon which we can agree, particularly when we are faced with an injustice that violates the fundamental tenets of both pro choice and pro life philosophy. Futile care laws are an example of such injustice.

Quietly creeping up for over a decade, futile care laws give doctors and hospitals the right to withdraw treatment from patients even when the patients have a living will or healthcare proxy expressing the desire to continue these measures. For instance, a patient on kidney dialysis may be refused further treatment because age, concurrent medical issues, or his or her likelihood of finding a suitable organ donor. A person on a respirator may be denied that treatment because she has a terminal illness, is quadrapalegic, or has some other condition requiring treatment that her doctor considers heroic. A conscious person who has had a stroke may be denied food and water even if it is requested, if such sustenance must be administred with mechanical assistance.

In general, futile care laws enable to following situation: Person A has a severe medical condition and/or disability. He or she desires to continue life sustaining treatment that the doctor considers futile or wasteful. The doctor brings the case to a hospital ethics committee, which, after deliberation, overrides the patient’s stated desires regarding treatment. The person and his or her family than have 10 (in Texas) to 14 days (in Virginia) to find another hospital that will treat them, or the treatment will be withdrawn, resulting in death. Unfortunately, many hospitals will not treat patients whose treatment is considered futile by another hospital, which condemns these patients and their families to hospital/state imposed death, or contentious court battles, often in their last few weeks of life.

This type of state and medically-sponsored, life and death
discrimination need not be encoded in a specific law to be a threat.
For instance, the 2005 Haliegh Poutre case involved MA social services
attempting to remove her feeding tube and ventilator against her
biological mother’s wishes (she had been abused by her adopted family),
which was only stopped when she began showing signs of alertness after
a judge gave the go-ahead to override her family’s wishes. Similar
cases have occured in New Jersey, Alaska, and other states without
specific futile care laws. Supportors of meaningful healthcare reform
must also remain vigilant against healthcare rationing that would
discriminate against the disabled and elderly and deny them the medical
treatment that they need.

 

Despite being a gross violation of both pro life and pro choice principles, these laws exist in states with Republican and Democratic leadership, indicating that this form of state-sponsored medical paternalism is not exclusive to either political party. The two most notable states with such laws are Texas, lead by governor Rick Perry (R) and Virginia, lead by Tim Kaine (D). In both cases, the laws were signed before these men took office, yet neither has taken action to rescind or ammend these laws. The media has also ignored these laws, and even organizations that are firmly committed to pro life and pro choice ideologies have drawn little attention to their activities in opposition to such laws.


People of good will on both sides of the abortion debate must join together to protect the common cause of universal human rights and justice. Together, we have the ability to make a difference and ensure that vulenerable people are not denied a choice about whether or not to continue recieving medical care, particularly when that medical care is the difference between life and death.

 

For more information, see the following links:

http://www.house.state.tx.us/committees/broadcasts.php?session=81&committeeCode=450

This links to testimony from Lanore Dixon, sister of Andrea Clark, who died in 2006 after a long battle between her, her family and the texas medical system.

http://studentsandcitizensagainstfutileethics.org/futile_care_aka_the_advance_directives_act.html

This links to my website/group, Students and Citizens Against Futile Ethics, which attempts to increase awareness of futile care laws and their impact on disabled people, as well as other disability rights issues.

 

 

 

 

 

 

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  • invalid-0

    I am not trying to be problematic, but what are the implications of “we want everything done” when the situation is truly futile? The Texas case of Emilio Gonzales was reviewed in the New England Journal of Medicine and his illness was described as “a progressive and fatal neurometabolic disorder.” This toddler spent many months in the intensive care unit with no hope of recovery. This likely cost millions of dollars. Texas has very high rates of uninsured patients, cervical cancer, teen age pregnancy etc etc etc. Would health care resources be better spent on simple preventive care?

  • progo35

    Anon-

    No, because Emilio had the right to continue receiving care without regard to his disability, per the Americans with Disabilities Act and Section 504 of the Rehabilitation Act.

    The problem here is doctors being paternalistic. It is not their job/right to decide whose treatment is too expensive and who can best benefit from monetary resources. The reason that I have generally supported universal health care, for instance, is so that people like Emilio can get the assistance they need. But, if the system is going to treat people based on cost and benefit analysis, we are going to end up abandoning patients in their hour of greatest need-when they are actually sick.

    "Well behaved women seldom make history."-Laurel Thatcher Ulrich

  • invalid-0

    Emilio’s doctors did not abandon him, I suspect they gave his family the very sad truth about his prognosis. This child was not diabled, he was terminally ill. Invasive medical procedures were not going to help him, there was no hope to reverse his illness. A prolonged stay in the intensive care was not going to change the eventual outcome – hence the term “futile.”

    As for monetary considerations, here is what was said in the New England Journal of Medicine “Although the clinicians in Austin consistently denied that they were motivated by financial considerations, concern about excessive expense may be an ethically legitimate reason to refuse continued treatment to patients like Emilio. Health care is not an unlimited resource, and physicians have an ethical obligation to ensure that it is distributed fairly.” The article appears in the July 5, 2007 edition of the New England Journal.

  • progo35

    Anon-

    Unfortunately, the New England Journal of Medicine isn’t necessarily concerned with patient rights in these matters. It is not uncommon for that particular Journal, along with Hastings, to support medical rationing. One of the major positions in terms of disability rights that is very important to remember is that “fairness” doesn’t mean “the same” share of medical resources. Emilio did not choose to be handicapped, and he had the right to continue receiving the treatment he needed until his illness went through it’s natural course. Moreover, FYI, terminal illnesses fall under the ADA and Section 504′s definition of disability as impairing a major life function.

    But, like I said, this comes down to a matter of principle. Are we, as pro life and pro choice individuals, going to allow doctors to decide what happens to our bodies and what happens to our lives? I hope not.

    "Well behaved women seldom make history."-Laurel Thatcher Ulrich

  • progo35

    See this blog:

    http://www.ourfrida.org/old-campaigns/emilio-gonzales/

    and these articles:
    http://www.dakotavoice.com/2007/03/national-disability-group-supports-efforts-to-save-emilio-gonzales/

    http://www.disabilitynation.net/episode/getting-elected-disability-and-update-emilio-gonzales

    http://www.dimenet.com/hotnews/archive.php?mode=A&id=6346

    I would like to point out that every major disability rights group in the country opposes these laws, yet many also support increased health care coverage-this indicates that those supporting this coverage expect to be treated equally without regard to their disability, until their natural deaths.

    "Well behaved women seldom make history."-Laurel Thatcher Ulrich

  • invalid-0

    Let’s please use words for their actual meaning, and not the flowery definitions whose use we have grown so complacent about. A natural progression of a terminal illness to a natural death would involve no medical intervention whatsoever. The definition of natural includes “in conformity with the ordinary course of nature; not unusual or exceptional” and “happening in the ordinary or usual course of things, without the intervention of accident, violence, etc”. All medicine is a form of intervention (and before you tell me it isn’t included in the definition, it is covered by etc. Hooking someone to a respirator, or inserting a feeding tube, is not natural. Were you born with a tube coming out of your stomach? I didn’t think so), making it by definition unnatural. It sounds harsh, but removing medical treatment in those cases deemed futile (terminal cases) is actually returning the individual to a natural progression towards their natural death. Everyone dies; in this day and age, most of us will die unnatural deaths (with the help of modern medical advancements). We can argue specifics and gray areas until we’re blue in the face, but please, let’s not redefine words.

    And before someone cleverly retorts that I am advocating the mistreatment of the elderly, those with disabilities, etc., please note that nowhere in my comment did I say that this natural progression was the best, absolute, and only way to go, nor did I suggest that I was against medical intervention in any way.

  • progo35

    Anon-

    I’m not making accusations at all. As for “natural” many people in the disability rights movement require intervention of some kind, so by natural, it usually means whenever the person actually dies with the assistant technology that is normally used. Ie, we are using a definition of natural that takes the lifelong need for intervention into account when determining natural death.

    "Well behaved women seldom make history."-Laurel Thatcher Ulrich

  • invalid-0

    I think we would all agree there are major differences between using a wheelchair for mobility vs. a ventilator with no hope of recovery.

  • progo35

    Not necessarily. For instance, some people who are quadrepalegic need respirators/ventilators to breath but are otherwise doing just fine. They should have the same right to continue dialysis or antibiotics as you or I would. Futile Care laws put those people in danger of having their ventilators pulled or treatment withheld under those laws.

    "Well behaved women seldom make history."-Laurel Thatcher Ulrich

  • progo35

    Every case is different, which is why these decisions about life and death are supposed to be up to the patients and their healthcare proxies, and not the doctors.

  • invalid-0

    okay let’s suppose I am 60 year old woman in Texas with breast cancer for ten years. This has been going on for several years and now I have extensive disease involving my lungs and bones. My doctor has recommended hospice care for me.

    Do I have the “right” to walk up to the front door of MD Anderson in Houston and demand care? More chemo and radiation even if there is no prospect improvement? Or a lung tranplant to get rid of my disease there? And the nurses and doctors at MD Anderson get no say in the situation?

  • progo35

    That’s right. If you want chemo and radiation, that is your choice, because it’s your body, your life, and only you should be able to determine whether or not you wish to stop treatment and go into hospice. As for transplants, that’s a stickier issue because you do have the right to request a transplant and/or fight the doctor’s decision not to put you on the list, but there are certain circumstances where transplants just aren’t possible. But, I’d say that if you felt that the doctor was just telling you that because you were 60 years old, than yes, you should fight it because you have the right to the same consideration that a twenty year old would get. The twenty year old isn’t more deserving simply by virtue of his or her age in this situation. The doctors shouldn’t have any say in whether you are going to die from a disease or injury at a certain time.

  • progo35

    http://medicalfutility.blogspot.com/2009/04/seven-reasons-that-might-justify.html

    "Well behaved women seldom make history."-Laurel Thatcher Ulrich