Human Exceptionalism

Imposing Futile Care Theory–Even When the Patient Improves

I have been warning for years that Futile Care theorists were going to become increasingly bold in attempting to impose their quality of life judgments on unwilling patients and families. A very important futility case is ongoing right now in Winnipeg, Canada, in which a hospital insists that it has the right to refuse wanted life-sustaining treatment–even though the patient’s condition has recently improved. From the story:

Two weeks after Samuel Golubchuk’s family went to court to stop doctors from pulling him off life support last month because he had minimal brain activity, he showed signs he was improving neurologically.

A week later, while doctors still argued to disconnect his ventilator and pull out his feeding tube, the 84-year-old Golubchuk was seen by medical staff to be “awake”. But on Friday in court, more than a month after the battle to keep him alive began, lawyers for the family and doctors were continuing to argue because the physicians say they still need to have control over deciding when to pull the plug.

After court, the family’s lawyer, Neil Kravetsky, said Golubchuk is alive today only because of the court’s intervention.”He would be dead if the injunction had been off,” Kravetsky said. “He is showing improvement and neurological responses according to his (hospital) chart. His eyes follow sound and movement. The chart says ‘awake’.”What does awake mean to you?”

If bioethicists and hospital administrators wanted to destroy the trust people have in medicine, they couldn’t find a better way to do it. And get this quote from the hospital’s lawyer–particularly the part I italicized:

But lawyer Bill Olson, who represents Grace hospital, said even if Golubchuk has improved, he still isn’t as well as he was when he entered the hospital’s intensive care unit and his prognosis continues to be dim.

So, how does the ubiquitous notion of “choice” compute with Futile Care Theory? It doesn’t. But that is because “choice” isn’t the real agenda. Imposing a quality of life ethic and imposing health care rationing is what medical futility is really all about. Indeed, one must work very hard to not see the direction in which the bioethical current is flowing.

Can we say, “duty to die?”

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