Monday, May 08, 2006

BioEthics and the Culture of Death

Joe Katzman relates this story, being followed by John Hawkins, about a woman named Andrea Clark in Houston, Texas, who has a bit of a problem.
She (Andrea's sister) told me that her sister recently had surgery for a heart condition. After surgery, she developed an infection and that's why she's so weak and needs a respirator to breathe. Again, her sister is not brain damaged, she can speak, and she does not want the hospital to let her die.
And yet that's what the hospital is doing. Enter the frustrating story of a woman, mother of a 23 year old man, who entered the hospital to have heart surgery, only to suffer an infection and other complications and have to remain there hooked up to a respirator and a dialysis machine.
From the sister:
The hospital ethics committee met the day before yesterday and concluded that Andrea's treatment (respirator and dialysis) should be discontinued. We have ten days to move her from that hospital or they will "pull the plug" and let Andrea die. Andrea, until a few days ago, when the physicians decided to increase her pain medication and anesthetize her into unconsciousness, was fully able to make her own medical decisions and had decided that she wanted life saving treatment until she dies naturally.
I.E. this is definitely not a Terry Schiavo case. Even in that case, it was the closest family member, the husband, making the decision to stop the machines. Here, for some reason, the hospital has the decision? People are starting the speculate that it's the insurance money that's causing the hospital to act in this way. And it's definitely not the "ethical, compassionate and quality care" that the hospital claims its mission is.

At this point I don't know what a lonely blogger like me can do about this. They are planning protests, and the media in Houston has latched on to the story, so I guess it's only a matter of time until the rest of the country knows what's going on.
The lawyer for Andrea has been trying to fight the hospital or find her a new one, but has run into roadblock after roadblock.
"Okay, I can't stand this anymore. First, we have tried facilities offering every conceivable level of care. She is on a respirator and getting dialysis. There are some nursing homes that offer respirator care and no dialysis and vice versa. The long term acute care facilities see that the hospital says she is "futile" and say they can't take her because they are there to rehabilitate and send patients to a lower continuum of care. Other hospitals rely on the "futility" diagnosis. A provider won't take a patient just on the say so of the family--they talk to the hospital. The hospital believes she is futile. It's a catch-22."
Oh, wait, that's not all. Then there's this:
Moreover, disturbingly, according to Ms. Childers there is a doctor at St. Luke's Episcopal Hospital who has examined her sister and said that he thinks she has a chance to recover. Imagine that, folks -- being sick, having the odds against you, but wanting to fight for your life -- and having the hospital that's treating you cut you off at the knees when you're at your most vulnerable.
So there's some dispute as to her condition, and the hospital thinks it's OK to make the decision to cut off support? Where's the ethics in that? Where is the AMA is all of this? When do we see state legislators and the governor speak up?
Katzman thinks that it's because of insurance that the priorities of doctors and medical facilities have shifted away from 100% patient needs to divided loyalties between patient needs and just how much they can provide.

TAANSTAFL, folks. There Ain't No Such Thing As a Free Lunch. The upside of third-party provided health care is that more people can receive treatment. The downside is that there is a price, and one part of that price is loss of control over that treatment.At the end of the day, medical resources have to be allocated somehow. Worse, since we all sicken and die, demand for these services will always outstrip supply. Handing care over to large systems, be they governments or HMOs, inevitably results in the large payers' priorities moving to the fore with respect to health care decisions.

Just keep that in mind the next time you go to the hospital. Or the next time you think that corporate or big government programs are the way to a better life for all of us.

No comments: