By Wesley J. Smith
Futile Care Theory has just taken a huge step toward nation-wide imposition with an official policy statement by the American Thoracic Society in collaboration with other medical and nursing associations involved with intensive care internationally. It is a frightening document.
The statement, essentially, creates a right of doctors and hospital bioethics committees to refuse wanted–and admittedly efficacious life-extending treatment–they prefer not to provide. It is like the sign over a restaurant door: We Reserve the Right to Refuse Service.
There are three parts of the document I need to quote to illustrate the danger posed by the Statement to people with profound disabilities, the elderly, and the dying who want to fight to stay alive. First, the admission that medical futility isn’t really “futile.” From the statement (my emphasis):
The term “potentially inappropriate” should be used, rather than “futile,” to describe treatments that have at least some chance of accomplishing the effect sought by the patient, but clinicians believe that competing ethical considerations justify not providing them.
Think carefully about that. Doctors are establishing the right to create a conflict of interest with patients by sacrificing their fiduciary obligation to each individual on the altar of other matters that should be of lesser concern, such as the cost of care, perceived societal betterment, personal disagreements with patient values, religion, or desire to live as long as achievable, the doctor’s/bioethicists’ belief in the quality of life ethic. There are the usual bromides about effective communication–and I am sure they think they mean it.
But realize, the document gives the ultimate power to strangers, rather than the patient or family–including the contents of an advance medical directive or POLST [Physicians Orders for Life Sustaining Treatment] order.
With that power structure firmly in place, communication can quickly devolved into coercion because everyone will know that the most the family/patient can do is stall the outcome, not actually prevent the refusal of treatment. If a bioethics committee–hold meetings which are held behind closed doors, are confidential, and doesn’t keep detailed records, such as transcriptions, etc.–rules that the treatment should be stopped, the onus is on the very sick patient or overmatched family to take protective action:
5. Offer surrogates the opportunity to transfer the patient to an alternate institution
6. Inform surrogates of the opportunity to pursue extramural appeal
7. Implement the decision of the resolution process
What about allowing the patient to find another doctor to provide the care in the hospital? After all, patients that sick are surely better off not moved. Alas, that common sense solution is not provided for, and would almost surely not be allowed.
And here’s where the organizations want their hammer of raw power reinforced by statutory law:
The medical profession should lead public engagement efforts and advocate for policies and legislation about when life-prolonging technologies should not be used.
Make no mistake, the Policy Statement seeks to further the power of the technocracy by enabling Obamacare cost/benefit panels to make decisions allowing the loss of insurance coverage for efficacious treatments a doctor or hospital consider “potentially inappropriate.” It is medical authoriarianism, the power of a doctor-imposed duty to die.
These decisions are value–not medical–judgments, as the Statement acknowledges. Rather than cooperating with this medical authoritarianism, lawmakers should pass laws preventing such impositions, or at the very least, requiring continued treatment until another facility or doctor can be found.
On the macro level, the centralized control that epitomizes the approach of Obamacare needs to be shattered. Fail to do that, and within a decade, we will all potentially face the duty to die.
Editor’s note. This appeared on Wesley’s great blog.