Threads by me.
A UK bioethicist named Daniel K. Sokol, who writes nary a word in opposition to Futile Care Theory, aka medical futility (meaning, I suspect, he is a futilitarian), has nonetheless written a valuable informative essay in the British Medical Journal (no link, 13 JUNE 2009 | Volume 338) called “The Slipperiness of Futility.” For example, he defines the different “kinds” of futility:
Although ethically aware clinicians need not be familiar with the vast literature on the concept of futility, they might wish to remember the following four points: • Futility is goal specific. • Physiological futility is when the proposed intervention cannot physiologically achieve the desired effect. It is the most objective type of futility judgment. • Quantitative futility is when the proposed intervention is highly unlikely to achieve the desired effect. • Qualitative futility is when the proposed intervention, if successful, will probably produce such a poor outcome that it is deemed best not to attempt it.
And he points out, physiological futility–which I think a physician should refuse–is the only objective “type.” Indeed, Futile Care Theory isn’t about truly futile interventions, but about withdrawing wanted treatment based on the medical team’s or bioethicists’ values:
As futility is so rhetorically powerful and semantically fuzzy, doctors may find it helpful to distinguish between physiological, quantitative, and qualitative futility. This classification reveals that a call of futility, far from being objective, can be coloured by the values of the person making the call. Like “best interests,” “futility” exudes a confident air of objectivity while concealing value judgments.
Sokol tries to erase the abandoning nature of Futile Care Theory by pulling out the old bromide:
Furthermore, “futile” suggests that nothing can be done. Recall the ancient medical wisdom: “To cure, sometimes. To relieve, often. To comfort, always.” There is always something to be done.
That’s true, as far as it goes, but when you want to live and the bioethicists/physicians don’t think the quality of life is worth the effort or the money, saying that you are still providing “care” rings pretty hollow.
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Stories like this continue to mount in the UK, and are a warning to us of the growing utilitarian, quality of life/cost-benefit bent in health care. A stroke patient, it is charged, was almost neglected to death–if not worse–at a UK hospital. From the story:
John MacGillivray, 78, from Auchterarder, was admitted to Perth Royal Infirmary having suffered a stroke on May 22. Two days later, his family were told by hospital doctors he would die within hours. His daughter Patricia MacGillivray told Sky News:…”There were several issues we already had with the level of care he had received in the short while he had been in the hospital, so we started to become suspicious. That’s when we started asking about his medication. It was then we learned that the medication we had been told he was going to receive when he was first admitted, which was specifically for stroke, had been changed to medication for treating seizures which we’d never seen him have.
The MacGillivray family instructed doctors to immediately withdraw all medication and launched a round-the-clock bedside watch.Within two days, Ms MacGillivray says her father had made such a good recovery he was being recommended for stroke rehabilitation treatment and four weeks later he was back home walking around his garden in Auchterarder. Ms MacGillivray feels if her family had not intervened in the treatment her father was receiving at Perth Royal Infirmary then her father would not be alive today. “The effect of that medication was to sedate him.”
Not to prejudge the matter, but I think that is a pretty good bet. Indeed, if my private e-mail is any judge, the disdain for the moral worth within the health care community for elderly people with serious brain injuries or illnesses is growing here too. (That being said, I believe American health care remains fundamentally moral precisely because of the people working in the trenches at hospitals and in nursing homes.)
Stories such as these are all very depressing and bring to mind the prescient warning by Dr. Leo Alexander printed in the New England Journal of Medicine in 1949 in the wake of the Nuremberg Medical Trials, for which he was chief investigator:
In an increasingly utilitarian society these patients [with chronic diseases] are being looked down upon with increasing definiteness as unwanted ballast. A certain amount of rather open contempt for the people who cannot be rehabilitated with present knowledge has developed. This is probably due to a good deal of unconscious hostility, because these people for whom there seem to be no effective remedies, have become a threat to newly acquired delusions of omnipotence… At this point, Americans should remember that the enormity of the euthanasia movement is present in their own midst.”
Question: Given the changes in ethics at the NEJM, given its editors pushing assisted suicide–even, in a bitter irony, respectfully publishing the Groningen Protocol bureucratic check list as to which babies are to be murdered by doctors based on quality of life judgments–would it even publish Alexander’s article today?
Thanks for the ping!
BILLY MAYS, oxyclean screamer: TAMPA, deceased. Hit in head by overhead luggage on flight. went home instead of ER. Word to the wise? Go to the ER if you have a head injury. (drudge lower left column for more) FV
Thread by Morgana.
Dozens of girls as young as 12 or 13 are regularly having abortions, Government figures show. More than 450 youngsters below the age of 14 ended unwanted pregnancies between 2005 and 2008 - including 23 girls aged just 12, the Department of Health statistics reveal. Over the same period, 52 teenagers terminated four or more pregnancies before they reached their 18th birthday, helping the number of repeat abortions hit record levels. Across all age groups, 64,715 repeat abortions were carried out last year. This is the biggest figure on record and includes 46 women who had terminated at least eight pregnancies. The figures will fuel fears that abortion is being used for lifestyle reasons by a generation that feels it has the right to have babies to order. They follow research published earlier this year, which found that the number of abortions performed on teenage girls who have had at least one before has risen by almost 70 per cent since 1991. In 2007, 5,897 girls under 20 had their second, third or even fourth termination. Sixteen years earlier, in 1991, the figure stood at just 2,934. Tory health spokesman Andrew Lansley said the statistics were evidence of the failure of Labour's teenage pregnancy policies. He said: 'When you look at the cases of young girls having abortions repeatedly, this is not just tragic and disturbing, but totally unnecessary.' The Department of Health spokesman said the Government had invested almost £50million in efforts to prevent teenage pregnancies and that the rates of abortions for teenagers as a whole had fallen by 4.5 per cent in the past year. . .