MDs Can’t Refuse to Kill, Can Refuse to Care

by Wesley J. Smith

As I have been–and will be–warning with intensifying urgency, moves are afoot to destroy medical conscience clauses under which doctors, nurses, and others can refuse to participate in abortions and assisted suicide. This force-MDs-to-kill meme was summarized in a recent Reuters story:

Physicians shouldn’t have the legal right to act as conscientious objectors and refuse to provide services like abortion or assisted suicide even when these things conflict with their personal values, some doctors argue.

But what about patients who want life-sustaining treatment, that is, they want to remain in the fight to stay alive?

Some of the same activists who argue that doctors should be forced to be complicit in killing, say that doctors should have the right to refuse wanted treatment that keeps patients alive.

Known as “futile care,” bioethicists see it as a way to save healthcare resources for patients with a better “quality of life.” Here’s a description in an earlier article I wrote about Texas’s futile care law:

This is how the Texas law, seen as a model by many futilitiarians, works: Under the Texas Health and Safety Code, if the physician disagrees with a patient’s decision to receive treatment, he or she can take it to the hospital bioethics committee. A hearing is convened at which all interested parties explain why they want or don’t want treatment to continue.

If the committee decides to refuse treatment, it is determinative. Even if the family finds another doctor willing to provide the treatment, it can’t be done in that hospital. At that point, the patient/family has a mere ten days to find another hospital willing to take the patient, after which, according to the statute, “the physician and health care facility are not obligated to provide life-sustaining treatment.”

In practical terms, that’s a death sentence. The economics of medicine have changed from the old fee-for-service days. Today, extended care in ICUs is usually a money loser for hospitals, meaning that families find it almost impossible to find a facility willing to accept the transfer of expensive patients whose care has been declared to be “futile.” There are even reported cases of desperate families looking out of state for a facility willing to provide treatment for a loved one about to be pushed out of the lifeboat by a Texas hospital.

So, here the bottom line. Autonomy rules if you want to die–even over medical conscience. But doctor/bioethicist’s values rule if you want to live.

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