Human Exceptionalism

Defeat for Futile Care in New Jersey

A case in NJ (Betancourt v. Trinitas Regional Medical Center, Docket No. C-12-09), in which the family of a 73-year-old man diagnosed to be in a persistent vegetative state sued a hospital attempting to unilaterally withdraw extensive life support, has been decided by a judge. Properly, the trial court ruled against the hospital based on patient autonomy, which the judge ruled, cannot be usurped by the courts or the hospital or doctors, but belongs properly to the patient or his/her surrogate decision maker. From the court ruling:

The decision to continue or terminate life support systems is not left to the courts. The position of the hospital argues that the court take the role of surrogate decision maker. The hospital seeks to have the court exercise its judgment in determining the proper course of treatment for Mr. Betancourt, a task…outside the role of this court.

The court concludes that Mr. Betancourt is in a persistent vegetative state and unable to communicate his wishes with respect to the continuation of life supporting treatment. Accordingly the appointment of a guardian is required. The court grants the application of plaintiff Jackqueline Betancourt to be the guardian of her father…As guardian for Mr. Betan court, Ms. Betancourt is his surrogate decision maker. The plaintiff’s application to restrain the defendant from discontinuing treatment of Mr. Betancourt is granted. The guardian is authorized to make decisions respecting medical treatment of Mr. Betancourt.

The treatment the guardian seeks is in furtherance of the quintessential purpose of medicine; extending the life of the patient. In this sense, it is non elective and the hospital seeks to stop it–not because it won’t extend Mr. Betancourt’s life–but because it probably will. Hence, the treatment is fulfilling its purpose. If the hospital won the case, doctors and bioethicists would, in effect, have been given the right to declare that the life of a patient diagnosed in a PVS is futile, and once that principle became well established in law and medical ethics, such ad hoc health care rationing wouldn’t end with catastrophically ill people such as this patient.

Please be clear: I am not saying that I would have made the same decision under the same circumstances if it were my mother–who has made very clear to me in an advance directive what she would want and not want. I am saying it is the family’s and the patient’s values that matter–not the doctors’ or hospital staff’s, or as the court properly ruled, a judge’s.

HT:I learned of this story from the blog Medical Futility, run by Thaddeus Mason Pope, a law professor at Widener University Law School. Pope is a futilitarian and I profoundly disagree with him on this issue. But I know of no better site covering medical futility on a consistent basis than Pope’s–and that includes SHS. And he does so in an even-handed and accurate manner, while still making his own views quite clear. If you want to see what is happening in the field of futile care theory, Pope’s blog is a must.


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