Terri Schiavo was dehydrated to death because she had supposedly told her husband and others that she would not want to live as an incapacitated woman. In other words, her food and water were taken away to honor her personal autonomy.

So, that must mean that seriously incapacitated patients who want to live also must have their desires respected, right? Wrong. In health care, patient "choice" is increasingly becoming a one-way street.

There are two kinds of "medical futility," and the difference between them is crucial to understand. If a patient or family requests care that will not work, it
is physiologically futile. As an extreme example: If I were to request that my appendix be removed to cure an earache, the doctor would--and should--say no. Why? The surgery would do nothing to cure my earache. Doctors can and should refuse physiologically futile care.

But this is not what Futile Care Theory is all about. Rather than refusing requested treatment because it will not work, the care is declined because it will. In other words, it is the patient--rather than the treatment--that is actually being declared to be futile. Thus Futile Care Theory involves personal values more than it does professional medical judgments.

According to articles in medical and bioethical journals, here is generally how bioethicists intend to impose Futile Care Theory on patients and their families in hospitals around the country:

• If there is a treatment withdrawal dispute between patient/family and doctors, the case will be referred to an internal hospital ethics committee "for adjudication."
• The committee members will hear from the doctors, family, nurses, social workers, and others involved in the case, as well as the patient or family.
• If the committee decides that the care should be provided, it will continue. But if it decides that the treatment should be withdrawn, life-sustaining care will no longer be provided in that hospital--even if another doctor volunteers to provide the care.
• At that point, the patient or family must find another hospital willing to provide the care. If that can't be done, the treatment will be withdrawn and the patient will probably die.

Nobody knows how many hospitals around the country have adopted Futile Care Theory as part of their end-of-life care protocols. But clearly, many have. An article published in the Cambridge Quarterly of Health Care Ethics in 2000 [Vol. 9, # 4, 2000, pp. 524-531] found that of 26 California hospitals surveyed, 24 accepted Futile Care Theory. Of these, all but 7 gave the final decision over withdrawal of wanted care to doctors or ethics committees rather than patients and their families.

If "choice" or patient autonomy is the foundational ethic of health care, none of this makes sense. But if the actual goal is the death of certain categories of "biologically tenacious" patients (in the words of one prominent bioethicist), then Futile Care Theory is perfectly logical.

These developments signal the creation of nothing less than a new medical ethic in which certain patients have a "duty to die", a concept explicitly under active consideration in contemporary bioethics discourse.

Remember Soylent Green?

While the 1970's sci-fi film's futuristic vision of overpopulation and environmental disaster has not materialized, the appalling utilitarian premise that people must die to fulfill their "social responsibility" lurks behind Futile Care Theory.

tothesource wonders if Soylent Green's "government sponsored euthanasia center" will be coming to a hospital near you?

Life and Death

Americans who support euthanasia for the terminally ill: 75%
Weekly church goers: 51%
Evangelical Christians: 61%

Americans supporting doctor-assisted suicide for people suffering incurable disease w/chronic pain: 58%
Weekly church goers: 30%
Evangelical Christians: 32%

Americans who say: I would not end my own life by some painless means if I suffered a painful, incurable disease: 35%
Weekly church goers: 69%
Evangelical Christians: 62%

Americans who say, Remove my life support in the case of a persistent
vegetative state with no hope of significant recovery: 85%
Weekly church goers: 75%
Evangelical Christians: 70%

Leadership Journal

Forewarned is forearmed:

The best protection against Futile Care Theory from being imposed against your will is a well-written, legally binding advance medical directive. It is not a good idea to sign a “living will,” since that gives the power to decide to doctors.

Rather, a durable power of attorney for health care or other such document permits each of us to decide who will make our health care decisions if we are unable to, and permits us to give specific instructions regarding the care we may want or not want. The International Task Force on Euthanasia and Assisted Suicide has created a state-specific “Protective Medical Decisions Document” (PMDD).

States pass Futile Care laws.

Futile Care Theory is quietly being adopted into state law. In Texas, for example, hospital ethics committees are authorized to refuse wanted life-sustaining treatment. At that point, the patient has 10 days to find another institution willing to provide the care. If no transfer is made, treatment can be discontinued.

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