Thread by me.
For years we have been told bioethics promotes patient autonomy. Want to refuse care even though you die, and the health care team disagrees? AUTONOMY! Want assisted suicide? AUTONOMY! Want to use every novel IVF procedure available to have a biologically related child? AUTONOMY! You want your life extended by intensive care and you so state in a living will or other advance directive? AUTONOMY–NOT!
My nearly twenty years as a critic of bioethics has convinced me that the field is not really about autonomy. Rather, it is about engineering proper outcomes as the reigning bioethical view determines them to be. If autonomy gets that accomplished, great. Bioethics loves “choice.” If not, well, so much for autonomy.
Thus, a paper about to be published in the Journal of Law and Medicine promoting a model futile care hospital protocol argues that patients and surrogates be made aware that the hospital has ultimate decision making authority: From Addressing Inappropriate Care Provision at the End of Life: A Policy Proposal for Hospitals:”
To provide for substantive reform, any proposed public policy or internal health care entity effort should address how best to:…
4. Ensure that the patient or their surrogate understands the physician and health care facility have decision-making options regarding continuation of treatment (my emphasis).
5. Facilitate understanding, either through ethics committees, or special communication teams, between the patient/surrogate and the physician/health care facility regarding how the patient’s treatment decisions are made and how the health care facility manages patients in end-of-life-care situations.
In the end, #s 4 and 5 above give final power to the hospital rather than the surrogate or patient. And make no mistake, this is about money:
Medically futile care creates challenges for hospitals attempting to provide effective and efficient care in a world of limited resources.
And it presumes to dictate that extending life–when that is what the patient/surrogates want–is not a medical benefit:
Further, although not all end-of-life care is inappropriate, some end-of-life medical treatment can be futile because the treatment will not result in any benefit for the patient and in some cases the patient would not have sought out such treatment had the patient been physically able to make the determination.
Don’t be fooled by language about treatment the patient wouldn’t want. The model policy would permit ethics committees to overrule a patient’s advance directive. Here’s what the article says should happen if the medical team or hospital ethics committee disagrees with a patient’s advance directive wanting care. If an informal process doesn’t achieve agreement, a formal ethics committee hearing is to be commenced:
• The patient or proxy should be provided at least 24 hours notice of the meeting of the committee.
• The patient’s physician should attend the meeting to explain the treatment options, with the patient/proxy in attendance, but then should be excused in order for the committee to discuss the particulars with the patient/proxy. The patient/proxy shall be permitted to ask questions of the physician during this time.
• The patient/proxy and the physician should be provided with the conclusions of the ethics committee, if a decision is reached…
Notice there is no provision for a formal record, no formal due process, no requirement to maintain accurate records of what was discussed at the meeting, no requirement for the committee to set forth its reasons, etc. In other words, an opaque and secretive process.
And if the family disagrees with the bioethics committee’s dictat?
If the ethics committee conclusions are consistent with the treating physician’s request, and the patient/proxy continues to disagree with such a determination, the physician must relinquish his or her responsibility for the patient’s care, and/or assist in the transfer of the patient to a physician who is willing to comply with the patient’s wishes, or, if required by law, must assist with the patient’s transfer to an alternative care setting within the health care facility or to a different facility.
And what happens if no other facility will take the patient? Hospitals increasingly either sue or refuse treatment unless directed otherwise by a court–meaning the patient surrogate has to sue.
Quality of life futile care theory imposes bioethical/hospital/doctor subjective values on patients and their families. Care isn’t deemed futile because it doesn’t work, but because it does. Hence, it is the patient being declared futile.
Good communication is important and I support ethics committees which work diligently to help people work through difficult circumstances. But they should not be given ultimate decision making authority. But no internal process should be allowed to make life and death decisions that overrule end-of-life desires of patients and their duly appointed surrogates. And this is particularly true, given the general unequal power and daunting institutional culture that can permeate hospital ethics committee deliberations.
Thread by topher.
March 18, 2011 (LifeSiteNews.com) - A homemade “bomb” akin to a Molotov cocktail was thrown at an elderly pro-life activist during a 40 Days for Life prayer vigil yesterday, March 17. The attack took place at around 6:15 p.m., near the All Family Health Care abortion center in Kalispell, Montana, according to the Thomas More Society (TMS)
According to Karen Trierweiler, coordinator of the 40 Days prayer vigils in Kalispell, the device was thrown at one of the vigil participants, an elderly retired woman, by an unidentified assailant as she walked on the public sidewalk near the abortion facility.
The victim did not see the thrower, nor did she see the device before it exploded on the sidewalk behind her, making a loud popping noise as it burst into flame. The victim was unhurt.
The victim then called Trierweiler to the scene, who called the police.
According to the TMS, which has filed a complaint with the FBI about the incident, a Kalispell police officer arrived only after a lengthy delay. The Society reports the police officer told the 40 Days prayer vigil participants that they should expect this kind of reaction if they’re out protesting.
“We are appalled by this terrible act of violence, while we’re immensely grateful that God’s grace spared this valiant pro-lifer any serious injury,” said Thomas Brejcha, president and chief counsel of the Thomas More Society.
Brejcha, however, took issue with the handling of the affair by the Kalispell police officer, calling his reaction “equally appalling, indeed outrageous.” Brejcha said they would be filing a disciplinary complaint against the officer and a desk sergeant who was also unhelpful.
“We expect much better from the FBI,” he said, “and we will pursue the matter to the very highest levels of the U.S. Department of Justice if this case is not investigated promptly and vigorously and - once the assailant is identified and apprehended - prosecuted to the hilt.”
Trierweiler also reported that an eyewitness has stepped forward, who was not part of the 40 Days campaign, but rather a passerby, who saw the incident occur and who may be able to help the FBI track down the bomb thrower.