Yesterday, I wrote about futilitarian law professor and blogger Thaddeus Pope’s “Seven Reasons That Might Justify Unilateral Refusal” of Medical Treatment, with my brief responses to each of the seven. Pope has apparently thought about it some more, and revised the post to now list the “eight” reasons. Accordingly, I respond here to the revised version.
In the original, Pope claimed that futile care impositions would protect patient autonomy–never mind that the point of futile care is to override patient autonomy made in an advance directive or overturn family decision making–the people who know the patient best. To go from seven to eight, he has divided the idea of protecting patient autonomy into two “reasons.” From the revised post:
2. Protect patient autonomy (re treatment): In many cases, the aggressive treatment demanded by a surrogate is treatment not wanted by the patient. And where patient preferences are unknown, continued treatment is not in the patient’s best interests.
But futile care theory is a frontal assault on patient autonomy, with some proposals even permitting patient advance directives to be overturned. If the patient truly did not want the treatment, that would not be futile care theory. Deciding in “the patient’s best interests,” would often really mean imposing the prevailing bioethical “quality of life” views onto patients. If the patient’s views are not known, the strong overriding presumption should be to continue the life of the patient as the surrogate requests.
Pope’s new “reason” is third (in order of importance) on his revised list:
3. Protect patient autonomy (re other things): Providing unwanted treatment not only violates the patient’s bodily integrity but also the patient’s autonomy concerning the location and manner of her death (ICU vs. home). It also causes the utilization of estate resources to pay medical bills that the patient wanted to go to other uses (e.g. grandchildren education).
Non medical issues, such as grand children’s college tuition or estate resources are none of the medical team’s business. If the patient wanted the treatment, or the duly authorized surrogate wants it, these matters should not be considered–and indeed cannot truly be known by bioethics committee members, doctors, or nurses. Besides, the choice in these cases isn’t going to be ICU or home, since by cutting off treatment the patient will probably die sooner rather than later in the ICU.
Futile Care Theory destroys patient autonomy, undermines the confidence of patients and families in the medical system, and superimposes the “quality of life” values of the bioethics elite on very sick people and their families.
Or to put it succinctly: education yes, coercion, no.