On this blog, Professor Thaddeus Mason Pope tracks judicial, legislative, policy, and academic developments concerning medical futility and the limits on individual autonomy at the end of life. For more resources, visit www.thaddeuspope.com.
This is such a hard case. Should guiding law on "medical futility" even be made on such tough and hard cases. His family, who loves him, does not want him to die, and wants all of the technology applied that will keep HOPE alive. It is instinctive to fight "death" and it seems immoral and inhuman to put a price tag on the costs of fighting death. But, of course, can we use the advanced medical technology to keep EVERYONE alive AS LONG AS POSSIBLE? Is this an impossible ideal or goal? How can we pay for this? Did VP Richard Chenney, who is 71get his heart transplant on his Government-provided insurance? Does that mean that all 71 year olds on Medicare will qualify for heart transplants? Who is paying for Mr. Rasouli's ongoing care? The Canadian government or Mr. Rasouli and his family? Obviously, all kinds of health care systems ---whether socialized or private ----will eventually have to fairly develop standards for "medical" and "fiscal" futility decisions. This, as Professor Pope, has indicated is the really tough problem to be solved in the years ahead.
Who pays for the care to date? Who pays for the care going forward? Who pays for the the equipment and the physical, occupational and speech & language therapies? Here's the part the media will never have the courage to cover, there are minimally- to fully-conscious patients with chronic critical illness (usually they cannot wean from mechanical ventilation, along with other very serious medical problems). Too sick to step down to a regular floor, to sick to go to a rehabilitation facility, to sick to go to a nursing home, to sick to go home, they are ultimately discharged, out-of-sight-out-of-mind, full code, tolerating very little rehabilitation, to Long Term Acute Care Facilities (LTACs), where they languish, waiting for the next exacerbation sending them back to the acute care hospital emergency department for admission to the ICU, again, then too sick to step down to an progressive cae unit or regular floor, they go back to the LTAC, having lost any incremental conditioning or strength they might have gained from what little rehab therapy they might have tolerated before. And so the cycle goes - ICU to LTAC to ICU to LTAC to ICU.... They never go home. They die somewhere in this cycle. To me this is an outer circle of Hell to which the system and family members relegate them in a cowardly, tunnel-vision death-prolongation process. The is no saving of life here. None of us are getting out of this alive. We all die sometime of something. Let your family members, who will never return to their previous selves, die in peace and some sort of dignity. If want to save lives ensure malnourished millions are fed, stop waging war, stop executing criminals. Don't inflict a set of vital signs on broken and ravaged bodies.May God have mercy on our souls for letting this sort of thing go on and for anyone involved in drumming up business to sell lottery tickets to Hell.
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