The medical/legal intelligentsia continues to promote empowering committees of “experts” to rule on which patients can receive wanted life-extending treatment and which should be refused based on “quality of life” and financial considerations.
Now an article by Thaddeus Mason Pope in the New York Law School Law Review urges the creation of multi-institutional ethics committees to make the thumbs up or thumbs down call.
Pope gives an excellent overview of the futile care legal landscape, so the article is worth reading on that basis alone. But I want to focus on how he urges creating distance between the imposers of futile care withdrawals of treatment and the family/patient.
Pope correctly identifies the subjective nature of medical futility (Futile Care Theory). From the article:
The life-sustaining treatment at issue in most medical futility disputes is physiologically effective. It can probably sustain the patient’s life for some period of time. Consequently, the clinician does not make a purely medical or scientific Judgment. Instead, she makes a value-laden judgment. The clinician judges that administering life-sustaining treatment is not worthwhile, because the risks and burdens of treatment are disproportionate to the diminished or non-existent opportunities for benefit
He further urges that these decisions be removed farther from the patient/family/local hospital as a way of making the committees less “biased, careless, and arbitrary.”
But I believe the opposite is true: That such multi-institutional boards will both remove the decision making from the bedside–and make it impossible for patients to find other local institutions to which the patient can be transferred.:
Reconstituting intramural ethics committees as multi-institutional committees can significantly mitigate these risks.Multi-institutional committees are equipped with the collective strength of multiple institutions’ financial, professional, educational, and disciplinary resources. And they are detached from what is often the unduly persuasive influence of individual supporting institutions. Consequently, the multi-institutional ethics committee can operate as a diverse, accountable, and independent decision making body that can ensure difficult bioethical dilemmas are addressed with enhanced uniformity and care.
Be clear: This is the establishment of a medical technocracy. And don’t think that once the principle is established that strangers can impose their values on patients and families that such actions will be limited to cases in the ICU!
Pope acknowledges that only about 5% of medical futility disputes become intractable. Then why resort to coercion?
If such death panels do come into being, kiss the remaining trust of the people in the medical system goodbye.