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: 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.
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.

Never mind that such expert calculations were part of a litigation in which the plaintiff’s lawyer is duty bound to make the damages appear as high as possible. The point is that if futilitarians get their way, and if PVS is deemed a condition for which it is inappropriate to provide sustenance, we are looking at the mass dehydration of tens of thousands of patients against their families’ desires, and perhaps against their own advance directives. Is the country really ready for that?

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.

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