Allowing people to make their own informed decisions regarding the extent of end-of-life medical treatment is crucial to respecting all people as persons. Indeed, that view was first promoted by the late great Paul Ramsey, the Christian theologian/bioethicist, in his pioneering lectures and subsequent book, The Patient as a Person.
Today, many bioethicists push to treat some patients as unpersons. One form of this assault is futile care theory—which presumes to give doctors and bioethicists the right to refuse wanted life-sustaining treatment based on their personal values—rather than those of patients and families. Most alarmingly, much advocacy for medical futility is coming from some Catholic hospitals and associations. Thus, as I criticized in the NRO—the Texas Catholic Conference opposed an attempt to revoke that state’s futile care law and the concept was vigorously promoted in the pages of Health Progress, the journal of the Catholic Health Association ( “Time For a Formalized Medical Futility Policy”).
Meanwhile, there is a futile care case in the New Jersey Supreme Court that may determine the legality imposing futile care in that state. I won’t get into the details of the case here. But let’s examine an apologia for futile care by Patricia Codey, a nun and head of the Catholic Healthcare Partnership of New Jersey, and Elizabeth Ryan, the CEO of the New Jersey Hospital Association. From their opinion column, “NJ Court Has Chance to Influence Compassionate End-of -Life Care:”
But the unprecedented science and technology available to us today cannot change one fact of life: There comes a time when death is inevitable. Science may be able to force air into a dying person’s lungs or pump nutrients into the digestive system. In short, science can prolong the dying process. But is that really what we want from our health care system?
This is classic in futile care advocacy. Rather than being described as extending life—cutting off wanted care is described as preventing an extended dying process. But some people want their lives—or the time it takes to die, if you prefer—extended in such cases. Futile care gives strangers the right to decide that even if you want to live in a terrible state, too bad, because we deem that your life is no longer a benefit to you, as the authors readily assert:
The question our society must confront is: Should health care professionals be required to use technology to prolong a dying patient’s life when those interventions violate longstanding medical ethics and standards, while providing no relief or benefit to the patient?
No, the real question is whether we want doctors/bioethicists/bean counters to say that life itself is of no benefit to the patient. Nor should we allow the medical system to devolve into a milieu in which only patient decisions for death are sacrosanct if the doctors/bioethicists/society disagree. But in more extreme cases, that is just what the authors advocate:
That’s why our organizations — the Catholic HealthCare Partnership of New Jersey and the New Jersey Hospital Association — have joined this case. Representing a faith-based organization and a secular health care association, we respect both the sanctity of life and the health care mission of healing and caring. The question our society must confront is: Should health care professionals be required to use technology to prolong a dying patient’s life when those interventions violate longstanding medical ethics and standards, while providing no relief or benefit to the patient?
It really rubs me wrong when religion (in this case, the piety of a nun and a Catholic health association)—which we are so often told should be forbidden in discussing public health policy—is pulled out of the hat as a justifyer to promote futile care theory without complaint from the usual secular bioethics crowd. I guess it just depends on whose ox is being gored. Back to the piece:
In striving for the proper balance, we must ask ourselves some key questions: How much care is the right amount of care? When do health care interventions — in the form of machinery and technology — become inhumane rather than heroic? What, in fact, is a death with dignity?...These questions are deeply personal, and that’s why we will continue to urge all individuals to state their end-of-life wishes through an advance directive or a health care proxy. But these very personal decisions are now becoming a societal issue as well — one that will confront physicians and families again and again in the years to come.
That’s not their decision, so long as the requested intervention is not physiologically futile and is a legitimate medical act. Moreover, futile care theory would permit hospitals to overrule patient’s advance directives, which we have been told for years should rule health care decision making.
I understand the arguments on the other side. But can we please stop pretending that futile care is about doing patients and their families with heterodox end-of-life views a favor? Coercion—because that is what we are talking about here—is not going to make the patient’s deaths go down any easier with the expression of such compassionate sentiments. Nor will futile care theory—and its even tougher older brother health care rationing—improve the public’s fraying faith and trust in the health care system overall.
