Medicine is becoming a one-way street. If a patient wants to refuse treatment in order to die–sacrosanct! That’s fine. But it should work both ways. Nope. Increasingly, if a patient wants treatment to extend life–not your call!
We are watching the slow motion imposition of a duty to die. Formal health care rationing is an example. But I think the greater threat is the imposition of an ad hoc duty to die in Futile Care Theory that allows doctors and hospital bioethicists to refuse to extend the lives of patients who they don’t think have lives worth living. (Here is an article I wrote explaining the concept.)
Futile care has led to much litigation around the world. So now, futilitarians are passing laws granting doctors the legal authority to impose their values on patients and families. Texas comes to mind in the USA.
Now, in South Australia, a new law will explicitly authorize doctors to refuse life-extending treatment–and there appears nothing that the patient or family will be able to do about it. From the Journal on Law and Medicine article:
Upon commencement of the reforms, new section 17(2) will read:
77 (2) A medical practitioner responsible for the treatment or care of a patient in the terminal phase of a terminal illness, or a person participating in the treatment or care of the patient under the medical practitioner’s supervision—
(a) is under no duty to use, or to continue to use, life sustaining measures in treating the patient if the effect of doing so would be merely to prolong life in a moribund state without any real prospect of recovery or in a persistent vegetative state (whether or not the patient or the patient’s representative has requested that such measures be used or continued); and
(b) must, if the patient or the patient’s representative so directs, withdraw life sustaining measures from the patient.
Moribund state? What if you want to live in a moribund state? Tough toenails!
Also: Notice that the law gives doctors a veto over the patient and the patient’s advance directive. If they think your time has come to die–your time has come to die!–even if you disagree.
For those who take comfort because they don’t live in South Australia, understand that these laws are as catching as a virus. It won’t be long until a similar proposal appears where you live.
And ponder this: Doctors-get-to-decide policies won’t long be contained to the ICU. Once the futile care principle is entrenched–and as the cost-cutting paradigm in medicine subsumes sanctity of life values–expect the enactment of increased medical authoritarianism in cases involving other forms of expensive care.
Bluntly stated, the decision of whether continuing to live with a serious illness and/or disabling conditions will soon not be ours to make.