Defending the Value of Unconscious Patients

The Huffington Post’s resident bioethicist, Jacob Appel, argued awhile back for cutting off care to patients in PVS in order to save resources for more “valuable” people.  I didn’t post on it at the time.  But an article at the Hastings Center Report rebutted Appel, and I think its conclusion is worth reproducing here. From, “Withholding Care from Vegetative Patients: Financial Savings and Social Costs,” by L. Syd Johnson:

While there may be some savings to be reaped from terminating the lives of patients with chronic disorders of consciousness, it will not be the substantial windfall that Appel imagines. Neither can it be assumed that “every dollar” will be diverted, as Appel suggests, to preventive care, or finding a cure for cancer. Public money saved could well be redirected to priorities outside health care.

There are substantial social costs to declaring an entire class of patients “worthless.” Allowing health care providers, including institutions like acute care hospitals, to unilaterally decide, against the wishes of patients or their legal guardians, to withhold life-sustaining medical treatment invites abuse and diminishes transparency and due process.

In a society that values patient autonomy and decisional authority, taking decisional power away from vulnerable patients or their surrogates would amount to abandoning them and leaving their fates to others who may or may not be motivated by patient welfare. It would change the culture of medicine – at least for these patients, if not for others – from one that is patient-centered to one that is beholden to the bottom line. In weighing the possible financial savings against the social costs of declaring these patients “worthless,” it is not at all obvious that ending treatment for all permanently vegetative patients will result in a net benefit.

We are already well down Worthless Road, I am afraid.  The very fact that we dehydrate such patients to death—which would bring prison if you did it to an animal—illustrates the course we are on, it seems to me.  That these patients are also being looked increasingly upon as splendid sources of organs or for use in medical experimentation as if they were cadavers instead of profoundly disabled people—a matter often discussed here—is another indication of where the quality of life ethic that permeates bioethics seeks to take us.  But good for Dr. Johnson for pushing back against the crass utilitarianism of Jacob Appel.  Every little bit helps.