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Death by Ethics Committee: Refusing to treat lives deemed unworthy of living

Wesley J. Smith

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Although some of the circumstances in this story have changed (Andrea Clarke died), Wesley J. Smith's warning about "futile care theory" is informative and relevant.

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.

Andrea Clarke may become an early victim of one of the biggest agendas in bioethics: Futile-care theory, a.k.a., medical futility. The idea behind futile-care theory goes something like this: In order to honor personal autonomy, if a patient refuses life-sustaining treatment, that wish is sacrosanct. But if a patient signed an advance medical directive instructing care to continue -- indeed, even if the patient can communicate that he or she wants life-sustaining treatment -- it can be withheld anyway if the doctors and/or the ethics committee believes that the quality of the patient's life renders it not worth living,

Contrary to how it sounds, medical futility is not a matter of refusing treatment that will not provide the medical benefit the patient seeks. Refusals of requests for such "physiologically futile care" would be proper and professional. For example, if a patient demanded that a doctor provide chemotherapy for an ulcer, the doctor should refuse, since chemo will do nothing to treat the ulcer.

But Clarke's case involves value judgments rather than medical determinations. 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.

Read the entire article on the National Review Online website (new window will open).

Posted: 14-Jun-06



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