Human Exceptionalism

More on Texas Bishops’ Embrace of Futile Care Theory

I consider the Texas fight over Futile Care Theory to be one of the most important bioethical matters of the year. This is why I was so profoundly disappointed when the Texas Catholic Bishops and the Texas Catholic Conference supported a modified version of futile care, and opposed the legislation to do away with the pernicious 10-day rule.

I write at some length about this in NRO, just out. Here is my conclusion:

What would drive administrators and ethicists at some Catholic hospitals to support Futile Care Theory? No doubt, partly a sincere desire to alleviate the suffering of the most ill and profoundly disabled patients. But social justice–the polite term for the money imperative– also cannot be left out of the equation. The care provided to patients involved in futility disputes is the most expensive. Boiled down to its essence, Futile Care Theory is a form of ad hoc health-care rationing that is at least partly designed to address the problem of tight resources in an era of managed care and HMOs. As the Ethics Committee of the Society of Critical Care Medicine said in a Consensus Statement back in 1997 supporting medical futility, “Given finite resources, institutional providers should define what constitutes inadvisable treatment and determine when such treatment will not be sustained”–which is precisely what the Texas law permits, and is now supported explicitly by the Texas bishops.

Near the end of his testimony, Bishop Aymond quoted the 1995 encyclical The Gospel of Life, in which John Paul II stated that in situations “when death is clearly imminent and inevitable, one can certainly in conscience refuse forms of treatment that would only secure precarious prolongation of life, so long as the normal care due to the sick person in similar cases is not interrupted.” But surely, John Paul II was referring to the right under Catholic moral teaching of patients and families to choose to forgo treatment–not the right of hospital ethics committee to impose such decisions upon the unwilling.

If patient autonomy is to retain any real meaning; if we are to prevent subjective and invidious quality-of-life value judgments from being imposed upon the sickest and most vulnerable among us–it is crucial that the Texas legislature kill the futile-care law’s 10-day rule once and for all. Unfortunately, the Texas bishops and Catholic Conference are impeding the success of this important work. In so doing, they are opening the door to the imposition of medical discrimination against those judged by strangers on ethics committees to have lives not worth living. Somehow, I don’t think this is what John Paul II had in mind.

I consider the Texas Futile Care fight to be of profound import, not only to Texas, but to the nation, and indeed, the world since this is a matter of growing urgency. It is in this context that the (in my view) abdication by Texas Catholic Conference is particularly unconscionable. Let us hope that right prevails.

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