Dorothy Livadas—New Futile Care Case in New York: Overruling Patient Advance Directives

This is the future that Futile Care theorists hold for us. If you sign an advance medical directive granting a proxy the right to make your health decisions on your behalf in the event of incapacity—and that proxy wants life support ceased—that decision is sacrosanct, and woe betide the outsider (even other family members) who try to interfere. But, if doctors decide that the proxy’s decision to maintain life support is “inappropriate,” well then, to hell with the advance directive, and indeed, to hell with the proxy.

Just such a scenario is unfolding today in Rochester. Dorothy Livadas named her daughter Ianthe to be her proxy. But Ianthe is exercising independent judgment requiring life support to continue that the hospital doesn’t want to provide, and so the hospital has sued to have her replaced by a proxy more malleable to the hospital’s desires. From the story:

The usual meme that “cure” is point, not life, was trotted out by the hospital:

Although not wishing to comment on the specifics of this case, the head of Intensive Care at Strong Memorial Hospital testified in a courtroom that there is no chance Dorothy will awaken or communicate. A doctor from Rochester General who was called in for a second opinion concurred.

So what, even if true? (And, as we have seen, such categorical pronouncements have often proved false, as in the Jesse Ramirez and Haleigh Poutre cases.) The proxy believes the life of Dorothy is what matters.

Surely courts would not agree! Please. Proxies and family members who value their loved ones lives aren’t capable of making “objective decisions,” don’t you know:

However, the courts have ruled that Ianthe Livadas no longer has a say in her mother’s care as Justice Harold Galloway awarded custody to Catholic Family Center. He said that Ianthe “fails to appreciate her mother’s true medical condition,” and that she “lacks the objectivity and insight to make necessary decisions.”

Here’s proof of a warning I have frequently made: Under Futile Care Theory, patient autonomy is one way street. Advance directives only matter if the proxy makes the “approved” decision. This is the beginning of the creation of a duty to die in which those with the power to decide push aside patients and duly appointed proxies who disagree in order to impose their own bioethical values on the rest of us. There’s a term for that; medical tyranny.

One final point: If we are going to have futile care theory imposed on us, this scenario is preferable to star chamber decision making by bioethics committees meeting in private session. At least here, there’s a right to appeal and a public proceeding so that the public can be appraised of what is happening. So, if a patient’s continued treatment is really torture, this is how it should be handled. But boy, this is a dangerous road that can only threaten the most vulnerable among us. And something should be done about the inequality of funds for lawyers in cases such as this. If a hospital wants to forcibly pull the plug, it should have to pay the legal fees of the family so they don’t go bankrupt trying to save their loved one’s life.