Secular Right | Reality & Reason

Jul/09

15

The Right to Refuse Medical Treatment

Share on FacebookTweet about this on TwitterShare on RedditShare on StumbleUponEmail this to someoneShare on TumblrShare on Google+

Commenting on my earlier post in support of changing the law on assisted suicide at least in the case of a physically incapacitated individual who wishes to die but has no realistic way of achieving that objective for himself, ‘Mark in Spokane’ makes the following point:

Ah, the “million-dollar baby” scenario. Except that any person in such a situation, so long as they are mentally competent, already has the legal right — recognized both constitutionally and at common law — to refuse medical treatment. For example, if an individual is on a ventilator and does not wish to be, they can refuse further treatment with the ventilator. That is already provided for in the law, and there is no need to go changing things to allow for a “right to suicide” (which really means, “a right to get help committing suicide”).

Unfortunately, Mark’s argument only works in the case of the patient who is dependent on constant medical support (that ventilator, say) to keep him alive. There will be other patients able to linger on for quite some time without medical assistance. As matters currently stand, their only options are either to wait for nature to take its course-however long that might take-or to try to starve themselves to death. Neither alternative strikes me as particularly humane.

No tags

15 comments

  • Mark in Spokane · July 15, 2009 at 3:10 pm

    Mr. Stuttaford,

    Could you provide some more detail to your additional scenario? I don’t understand why the person you describe would not be able to commit suicide without assistance.

  • kurt9 · July 15, 2009 at 3:18 pm

    Some background on the Thomas Donaldson case:

    http://www.alcor.org/Library/html/Donaldson-VanDeKampAbstract.html

  • Derek Scruggs · July 16, 2009 at 6:32 am

    @Mark in Spokane, a quadraplegic cannot commit suicide without assistance, expect perhaps via a hunger strike.

  • Andrew Stuttaford · July 16, 2009 at 7:45 am

    Mark, ‘locked-in syndrome’ would be an example of what I am talking about. Patients are almost totally immobile, but (it depends on the circumstances of the case) not necessarily immediately dependent for their survival upon medical treatment that can be refused or medical equipment (such as a ventilator) that can be switched off.

  • Mark in Spokane · July 16, 2009 at 10:45 am

    Mr. Stuttaford,

    How would a person with “locked-in syndrome” communicate a desire to be euthanized?

    I use that word quite deliberately, because such a person would not be a candidate for “assisted suicide.” In assisted suicide, the individual herself actually takes her life — the person who “assists” simply procures medicine. In the case of a physician, by prescription. For another individual to actively kill another upon request is euthanasia. At least that’s how I understand those terms.

    So, when you discuss a “right to die,” you are including euthanasia, and not just assisted suicide, then? Is that a fair characterization. I just want to be clear before I respond.

    Thank you.

  • Spawn of Cthulhu · July 16, 2009 at 6:08 pm

    Communication in locked-in syndrome is generally done with eye movements (blinking once for yes, twice for no, etc). Death in this case would occur after several days if feedings and hydration were withheld/withdrawn (as in the Schiavo case).
    NO active participation by a physician would be required. It may seem like a nuance, but to a physician (I am one) there is a big difference between giving a fatal dose of medicine (a narcotic perhaps) and simply withdrawing nutrients and allowing death to result in time.

  • Mark in Spokane · July 16, 2009 at 9:59 pm

    Spawn,

    Your basic position is the same as that adopted by the law currently. A patient has a right to refuse care — including nutrition and hydration, but not a right (outside of Oregon and Washington states) to assisted suicide or euthanasia.

    At the end of the day, my basic concern with allowing assisted suicide and/or euthanasia has to do with the fact — and it is seen in Oregon in the Wagner case — that once killing a patient is seen as a proper protocol, it will become the preferred protcol in order to save money. $4,000 a month chemo treatment to extend life compare to $50 worth of narcotics to end it. In the real world, which treatment option is the state going to favor? Which treatment option will insurance companies favor? What treatment option will the family/next of kin/legal guardian/court-appointed power of attorney favor? In the real world now — not in a libertarian utopia where everybody’s private choice is honored; not in a fairy-tale socialized medicine scenario where everybody gets the same level of medical care as a member of Congress; not in a made-for-t.v.-movie world where every old person is a beloved grandparent surrounded by a loving and supportive family. In the real, messy, cheap, grubby-family-fighting-over-the-inheritance, bureacrats-drunk-on-power world.

    There is a balancing of concerns here, no question. I don’t mean to slight the views of Mr. Stuttaford and others who believe in assisted suicide or euthanasia. But on the whole, I think that given the high likelihood of abuse — abuse which is not speculative but which is happening in our system already in the places where assisted suicide is legal — I think that providing for assisted suicide is prudentially unwise This is particularly the case given the options to refuse treatment which already exist. When combined with appropriate pallative care, that would appear to me to be sufficient to allow for a humane end of life without the problematic elements that are part and parcel of assisted suicide and euthanasia regimes. When the perfect isn’t possible, the good shouldn’t be disqualified on the grounds of its imperfection.

  • Spawn of Cthulhu · July 17, 2009 at 11:26 am

    Very nice long reply.
    My main concern with assisted suicide is that I personally don’t feel that physicians should be actively killing people, in general. Yes, there are certainly gray areas and the like (for example, battlefield scenarios such as in “Saving Private Ryan” where providing large doses of morphine may be all one can do to a mortally wounded and suffering soldier), but in reality these don’t come legitimately into play often.
    Rather, as mentioned above (and we’re in agreement about this), withdrawal of care (say, after brain death resulting from a drowning episode or massive cardiac arrest, and based upon the patient’s prior directive or his family’s careful decision) is very different from the physician’s active participation in death. There is a very long tradition (a conservative one that antedates our Judeo-Christian heritage) that physicians should not harm their patients. This is a slippery slope that I feel is dangerous to my profession.
    I don’t think that your concerns about insurance companies/the government/financial managers and the like making decisions in favor of suicide to save money is likely, because I feel that no physician with any moral feelings would permit this or take part. Perhaps I’m somewhat of an idealist and there are enough of us who could turn to the dark side with proper inducements. If so, maybe we’ll all end up like Edward G. Robinson in “Soylent Green”.

  • sg · July 17, 2009 at 2:47 pm

    At least an overdose of narcotic is fast and painless. I understand that most of us would prefer not to actively participate, but if that means starvation or dehydration, I don’t see that as showing concern for the suffering of the patient. I would sooner sign/blink consent for lethal injection than starvation and dehydration which is horribly painful and lengthy. If any method of assisted suicide should be expressly prohibited, it should be starvation and dehydration.

  • Mark in Spokane · July 17, 2009 at 2:52 pm

    Spawn,

    Yes, we are both pretty much agreed on this. As for the govt./insurance companies pressuring people, I don’t necessarily think the pressure would be applied via the doctor. The pressure comes from a decision by the medical care funding bureacracy to deny treatment to extend life and to provide funding for the treatment to end it. That’s what happened in the Wagner case in Oregon. Wagner was on the Oregon public health insurance plan, her doctor wanted to put her on chemotherapy to extend her life (she had a recurrence of lung cancer), the state denied her claim for the chemo, but then offered up that it would happily pay her for her treatment if she chose to kill herself. Her doctor very much wanted her to get the treatment. It was the state — the provider of funds — that refused. I think that once the assisted suicide/euthanasia option becomes open and available and legal, that’s where we’re headed, particularly given the push for socialized medicine and rationing.

  • Spawn of Cthulhu · July 17, 2009 at 6:17 pm

    @Mark in Spokane
    After reconsidering, I agree that I am overly naive. Once a soulless (I mean that figuratively) bureaucracy gains control, decisions can and will be made that no individual would ever have the guts to make or sign their name to. I’d forgotten about the case you cited, but was thinking more about what’s going on in the UK in general (not just the NHS, but with the police, educational establishment, etc).
    I’ve been interviewed by a government agency who was involved in the prosecution of physicians in my local area for such things as illegally prescribing narcotics and billing fraud (I wasn’t a target, they were using me as background as an Emergency physician who’d cared for some of their patients and was familiar with their abuses). Certainly for a small fee these guys (now either serving long terms or about to be) would’ve signed off on an order that the vast majority of us would never touch.

  • Spawn of Cthulhu · July 17, 2009 at 6:29 pm

    @sg
    Hospice services deal with this situation routinely in that patients with terminal conditions are allowed to die peacefully and without pain and suffering. It may be hard to believe, but it is certainly true.
    Maybe it’s just an ethical point, but once we start terminating patients actively, the question, as raised above, is do we start going too far and begin to sway people aggressively to agree with us. There have been occasional allegations already that organ transplant teams have been removing organs from still living donors prematurely.
    In my personal experience in the ER, withdrawal of care doesn’t happen often (as mentioned above it’s usually someone who’s put on a ventilator and then as the resuscitation continues we realize that they are going to be brain dead, a good example being someone with a massive brain hemorrhage that’s not operable or survivable). In a case such as this I’ll have a long talk with the family and will review the patient’s advance directives, if they exist. If the family’s willing, then disconnecting the patient from the ventilator will be done with death resulting often in 15 minutes or so. There is nothing painful or prolonged in a case such as this.

  • sg · July 18, 2009 at 10:21 am

    Spawn,

    I am fine with withdrawing medical care. Food and water do not amount to medical care. If a person is going to die, food and water will not save them, conversely, someone who could recover will die from lack of food and water.

  • Mark in Spokane · July 18, 2009 at 9:08 pm

    Spawn,

    I’m glad anytime someone becomes less naive! Your comment on hospice was spot on. I had an aunt with terminal cancer who received hospice care, and she indicated that it made her experience with terminal illness considerably less frightening and anxious. She was comfortable, her pain was reasonably controlled, and she had ample opportunity to see family and friends. I imagine that not every hospice experience is postive, but for her it was.

  • Shuffling Off This Mortal Coil « Around The Sphere · July 20, 2009 at 11:01 am

    […] Stuttaford, here and here: John, when it comes to something that is quite literally a matter of life and death, I think that […]

<<

>>

Theme Design by devolux.nh2.me