Imagine your mother is in the hospital. She has written an advance medical directive instructing that her life be maintained even if things look very bleak. She has told you personally in an intense and intimate conversation, that she wants you to make sure everything is done to let her fight for her life.
A year later, your mother has a stroke and is fighting for life in an ICU. You try to do as she wanted, you instruct her doctors to maintain her life. But they say no. She is very unlikely to recover, and even if she does, she will be seriously disabled. Her “time” has come, they say. And then, they unilaterally remove her life support over your strenuous objections.
That kind of authoritarianism already happens in Texas and a few other states. Now, Nevada has a bill pending in the legislature that would permit doctors to push patients off wanted life-extending treatment. From SP 189:
A medical facility is not subject to disciplinary action, shall not be found to have violated any standard of care and is immune from civil and criminal liability for refusing to provide care or treatment requested by a patient at the medical facility, or by another person on behalf of such a patient, if a provider of health care:
1: Has determined that the treatment of care would not be effective or is contrary to reasonable medical standards.
This is a bioethics meme known as “medical futility,” “futile care,” “inappropriate care,” or “non-beneficial care” — the bioethicists are still working on the best lexicon to get their policy goals enacted.
The point of futile care is not to protect doctors from forced provision of treatment that isn’t working — sometimes called physiological futility. Rather, it is to enable doctors to stop treatment even though it is accomplishing what the patient wants, i.e., maintaining life. Here are some important points to ponder when considering this issue:
- Futile care says maintaining life when the patients wants to stay alive is not an appropriate intervention in some cases.
- Proclaiming treatment futile or inappropriate is a value judgment–not a medical determination — about whether the life in question is worth living, and/or worth paying to sustain. It essentially declares the patient futile.
- Futile care decisions may be distorted by prejudice against disabled patients, the elderly, and other minorities.
- Futile care involves collective decision-making that empowers strangers to make crucial decisions about a person’s life and death. It gives greater weight to institutional and professional values than to those of the patient and his or her family.
- Futile care is a form of ad hoc health care rationing. That means an intervention considered futile in one hospital might not be in another.
If Nevada legalizes assisted suicide, which is being attempted this term, and also passes this futile care bill, the lives of the most medically vulnerable will be put at material risk both coming and going. If a dying patient wants to commit suicide, great. Bioethicists believe in patient autonomy, so the law will authorize doctors to give them the poison pills.
But if a patient wants to continue to stay alive on life support, suddenly patient autonomy will have its limits and the subjective values of doctors and bioethicists could trump those of patients and families.
That’s known as heads we win, tails you lose. Let’s hope that the Nevada Legislature rejects this awful bill.