Wesley Smith and this Blog

Wesley Smith is one of the most prolific and articulate opponents of what he calls "futile care theory." And he regularly writes about futility disputes on his blog, Secondhand Smoke: Your 24/7 Bioethics Seminar. Today, Wesley blogged about this blog:

I just learned about this blog, "Medical Futility," that tracks futility care cases. The author is a law professor named Thaddeus Pope who, from what I have seen of his entries, clearly supports Futile Care Theory. In reading his entries, it validates my belief that the twin ideological beliefs behind Futile Care Theory are a feeling of repugnance about the lives of people with profound disabilities and a utilitarian view that maintaining their lives is, therefore, a waste of money. In this entry, Professor Pope reports that medical students apparently believe it is wrong to sustain the lives of patients diagnosed with PVS. He doesn't comment, but based on the next entry, he no doubt approves. Professor Pope seems to support cutting off all patients' with profound cognitive disabilities--meaning feeding tubes for those who need no other interventions--because of the cost of their care: [quoting from my $6b post] Never mind that such expert calculations were part of a litigation in which the plaintiff's lawyer is duty bound to make the damages appear as high as possible. The point is that if futilitarians get their way, and if PVS is deemed a condition for which it is inappropriate to provide sustenance, we are looking at the mass dehydration of tens of thousands of patients against their families' desires, and perhaps against their own advance directives. Is the country really ready for that? If that prospect ever became an imminent reality, I have no doubt that we wouldn't resort to mass dehydration to rid us of these useless eaters, but instead would opt for the lethal injection as more humane. Cheaper too. Now, let's see. Dehydration takes 12-14 days. The cost of the care for those days for all of the patients would amount to the tens of millions. Yup. Inject them. We have better uses for that money.

I responded earlier this evening:

Wesley, Please allow me to make two clarifications. (1) First, you write: "Thaddeus Pope . . .clearly supports Futile Care Theory." While I do generally support and defend the health care provider's position in futility disputes, I do NOT do so categorically. For example, my next law review article is a sustained attack on the procedural fairness of the unilateral refusal provisions in the Texas Advance Directives Act. (2) Second, you write: "Professor Pope seems to support cutting off all patients with profound cognitive disabilities." This is most certainly NOT my position. Nothing in my blogs or law review articles suggests that I espouse such a position. I support "cutting off" ONLY those patients who are brain dead or in a PVS. Even highly distinguished disability scholars and advocates (e.g. Adrienne Asch) except PVS patients from the rest of the physically and mentally disabled.

Wesley Smith then responded to my comment on his blog:

Professor Pope: Thanks for dropping by. You prove my point. To claim that those diagnosed as PVS are not profoundly disabled--by the way an often misdiagnosed condition--is ludicrous and simply a way out of the harshness of the position. It is to dehumanize our brothers and sisters and push them out of the human condition. Be that as it may: You certainly do advocate the mass dehydration of 25,000 patients you identifed as PVS on your blog site. That seems inescapable to me. And it is abhorent.

Finally, I then responded to Wesley's response to my comment:

Wesley: I agree with both your points -- to an extent. (1) First, I AGREE that failing to provide life-sustaining treatment to PVS patients is to treat them as though they are "out of the human condition." But I DISAGREE that it is to "dehumanize" or "push them" out. Dehumanization is already a consequence of their condition. (2) Second, I AGREE that PVS patients should be allowed life-sustaining medical treatment if they can (and many do) find a provider to provide it. I certainly do not advocate the "mass dehydration" of PVS patients. Futility disputes occur when surrogate decision makers ask physicians to provide health care that the physician thinks is inappropriate. If the surrogate and the physician agree on the treatment (e.g. ANH for a PVS patient), then I would not interfere with that. I simply DISAGREE that an individual provider who considers treatment of a PVS patient inappropriate must continue to treat that patient.