"Death by Philanthropy
A recent episode illustrates the role of foundation funding in promoting Futile Care Theory or protecting us from it. Dr. Donald J. Murphy, a Colorado physician and ethics consultant, a prominent proponent of medical futility, believes that “the community” should define when and under what circumstances it is inappropriate for doctors to provide medical treatment.
Murphy once headed a nonprofit organization, the Colorado Collective for Medical Decisions (CCMD), dedicated to crafting formal guidelines it hoped would come to govern when life—supporting medical treatment would be withdrawn from patients—whether or not the patient or the patient’s family wanted the treatment to continue.
To promote his organization’s agenda, Murphy approached the Colorado Trust, a philanthropic foundation dedicated to funding projects designed to promote “accessible and affordable healthcare programs.”
The Trust granted CCMD $1.3 million to develop its guidelines. “It was a unique grant,” says Nancy Baughman Csuti, senior evaluation officer for the Colorado Trust. “It was not done in response to a Request For Proposals. Dr. Murphy just came in as the leader of his organization and made a strong presentation asking for the money.”
CCMD used the Colorado Trust’s donation to convene community focus groups intended to determine-and mold-the public’s attitudes towards end-of-life care. Murphy’s purpose was to generate so much public agreement with CCMD’s proposed guidelines that hospitals, HMOs, and physicians would be emboldened immediately to begin the widespread withholding of “inappropriate” care. To Dr. Murphy’s chagrin, “the community” generally rejected Futile Care Theory. “It became clear that people believe that they should be in control of their own care,” Csuti says.
Seeing the writing on the wall, the Colorado Trust ceased funding CCMD and used the information gleaned from the focus groups to help craft a new Palliative Care Initiative, by which it hopes to promote better and more humane medical treatment at the end of life-a program not based on a coercive model.
Why the change? Says Csuti: “Our foundation believes that the community must buy into new approaches to medicine. It became clear that the guidelines would not fly. So, the foundation is now pursuing a different path.”
In an ironic postscript to the story demonstrating that groups that live by philanthropy can also die by philanthropy, the loss of the Colorado Trust’s funding dealt a deathblow to CCMD. Dr. Murphy has moved on to new endeavors and the organization is no longer active.
The moral wreckage of the eugenics movement should serve as a warning sign against embracing discriminatory policies as proper solutions to social and medical problems.
When making their funding decisions, donors would thus do well to ponder whether their support for a specific bioethical activity would be likely to move the nation forward to a more just and accessible medical system or would, in the name of progress, actually undermine the cornerstone principle of universal human equality. With foundation-funded bioethicists leading us incrementally in the direction of a “new eugenics,” due diligence demands nothing less."