Oh, oh. NYU Bioethicist Art Caplan seems to suggest–in the context of a story about former Israeli Prime Minister Ariel Sharon–that we should not maintain people like Terri Schiavo and others, who are either in a persistent vegetative or minimally conscious state–this even though new research suggests that at least some are more aware than thought previously. From the PRI story:
What these new technologies can reveal about brain activity is important, Caplan said, but it’s important not to overstate their importance, because people end up in a comatose state for different reasons. “Even though people see certain things going on in someone in a permanent vegetative state, there are some reflexes there. They are digesting their food, they’re not dead, there’s some brain activity, we have to realize the quality of life can be awful,” he said. In Sharon’s case, Caplan said, he’s in a state that’s starting to be called “minimally conscious.”
“But in all these situations, let’s keep in mind, people of goodwill, loving family members, partners, friends, they could still say ‘I don’t care if his brain is active, he would not want to be bed-bound, in a minimally conscious state. That’s not a situation I want to prolong with technology,’” he said. But the sort of care that’s needed for these people can be incredibly costly. It can also take up valuable spots in hospitals and intensive care units. Caplan says family members should consider alternative means of caring for their relatives, if they find them in such a state. “We shouldn’t have 5,000 to 10, 000 people in intensive care in the United States alone, when we can barely provide basic care for our children,” he said.
The term “intensive care” in the last sentence is inaccurate in many–perhaps most–cases, since the vast majority of such patients are not hooked up to “machines” in the ICUs of hospitals–at least in the long term–but already receive skilled nursing or in-home care rather than remaining in hospital. Moreover, quite a few don’t even need respirators, just food and water, warmth–and hey, how about a little love–like Terri Schiavo’s family wanted to give her.
But to Caplan’s last point: If we “shouldn’t” have these patients draining our finances, what should be done to prevent it, particularly since we don’t permanently maintain most of these patients in ICUs now? Sounds like implied death panel talk to me!