Sunday, August 06, 2006

Nebraska Humane Care Amendment -- The Next Installment

Here is the next "installment" from the FAQ document provided by the people leading the charge for the Nebraska Humane Care Amendment, a measure that I am on public record as supporting. The first in this series was posted on Vital Signs Blog right here. The others will be forthcoming...

Are Nebraskans really at risk for involuntary, institutional dehydration/starvation?

Yes. So-called “futile care” policies being adopted by HMO’s, hospital chains, so-called non-profit health systems, and interstate corps across the nation now threaten us with denial of wanted life-saving care in general -- and in particular, with the guaranteed-fatal denial of food and water. Consider:

* We hope that the battle that we fought for our sister will bring to light and bear witness to the horrible acts committed in the name of ethics in hospitals across the state of Texas. The fact that we had to fight this battle is both frightening and a sad commentary on the so-called "ethics" now being practiced in medical facilities in this state….We wish so much that we could have spent more time at our sister's side, when she was living and fighting for her life, rather than having to visit our attorney's office, give interviews to radio and television stations to let the public know of the atrocity about to befall Andrea, and literally stand outside the hospital and beg them not to kill our sister. In attempting to deprive Andrea of the most basic of her human rights--life--St. Luke's Hospital managed to deprive her family and her of that which is most dear to us all, when we are faced with the death of a loved one: a proper goodbye. How, in the name of God, anyone can call putting someone to death when they are at their most helpless and begging for their lives “ethical,” we cannot imagine. (Melanie Childers, sister of Andrea Clarke, Democratic, 5/8/06).

* The bioethics committee at St. Luke's Hospital in Houston, Texas has decreed that Andrea Clarke should die. Indeed, after a closed-door hearing, it ordered all further medical efforts to sustain her life while at St. Luke's to cease. As a consequence, Clarke's life support, required because of a heart condition and bleeding on the brain, is to be removed unilaterally even though she is not unconscious and her family wants treatment to continue. (National Review Online, 4/27/06). Denial of food and water, even to a patient who wants it and whose family seeks it, is within the “futile care” policy options of Houston hospitals.

* As you read these words, quietly, slowly, inexorably, mostly behind the closed doors of hospital ethics committees, “futile care” or “inappropriate care” protocols are being put into place in hospitals throughout the country. The first time most patients and their families become aware that doctors are being given the right to say “no” to wanted medical treatment … is during a medical crisis when they are at their most defenseless and vulnerable. Hospitals in Des Moines, Iowa, appear to be the latest institutions to stealthily adopt futile-care policies. As reported by the January 2, 2003, Cedar Falls Courier, some area hospitals now have rules in place that permit "medical staff to withdraw treatment over a family's objection." (National Review Online, 1/6/03)

* The Cambridge Quarterly of Health Care Ethics (Fall 2000) reviewed so-called “futility” policies of 26 California hospitals. Only one provided that "doctors should act to support the patient's life" when life-extending care is wanted by the patient. All but two hospitals "defined circumstances in which treatments should be considered nonobligatory even if requested by the patient or patient representative." In sum, 24 of the 26 hospitals studied permit unilateral denial of wanted, life-supporting care.

* Contrary to how it sounds, medical futility is not a matter of refusing treatment that will not provide the medical benefit the patient seeks. … In such “qualitative futility” cases, treatment is stopped in spite of a patient's or family's objections — the intervention is necessary not because the treatment doesn't work, but because it does. In essence then, it is the patient's life that is deemed futile and, hence, not worthy of being preserved. Texas, however, has become ground zero for futile-care theory thanks to a draconian state law… that explicitly permits a hospital ethics committee to refuse wanted life-sustaining care. Under the Texas Health and Safety Code, if the physician disagrees with a patient's decision to receive treatment, he or she can take it to the hospital ethics committee. …If the committee decides to refuse treatment …the patient/family has a mere ten days to find another hospital willing to provide the care, after which, according to the statute, “the physician and health care facility are not obligated to provide life-sustaining treatment.” (National Review Online, 4/27/06).

* Massachusetts' child welfare chief said his agency didn't tell the state's highest court that a brain-injured girl at the center of a right-to-die legal battle might be getting better because doctors convinced him she would never recover from a vegetative state. Department of Social Services Commissioner Harry Spence has been criticized for moving too quickly to try ending Haleigh Poutre's life support. He's also come under fire for not seeking more medical opinions on her chance for recovery. Authorities say Haleigh, who is now 12 and in a rehabilitation hospital, was beaten nearly to death by her adoptive mother and stepfather. Spence said Haleigh was showing signs of responsiveness about a week before the Supreme Judicial Court granted permission to remove her life support. But he said Haleigh's doctors said her movements were not a sign she would recover…."They absolutely affirmed that the chances of her recovery were absolutely zero. There was nothing for us to report to the SJC. There was nothing that had changed." Immediately after the SJC's Jan. 17 ruling that Haleigh's life support could be removed, Spence said he ordered the girl's doctors at Baystate Medical Center in Springfield to examine her again. "They said `oops, we're seeing signs of consciousness,'" Spence said. (Associated Press, 3/23/06)