Saturday, February 18, 2006

Utilitarian Medicine in the UK

Wesley J. Smith at Secondhand Smoke writes about healthcare rationing in the UK,

The case in question involves a woman who has a type of breast cancer that is susceptible to treatment by a drug called Herceptin. The drug is expensive and the patient, Ann Marie Rogers, was denied access to it by the NHS—not because of efficacy concerns, but apparently based on cost. (Only late stage breast cancer patients can have the drug paid for by the NHS even though it also shows great promise in early disease.)

The high court in the UK (the equivalent to the U.S. Supreme Court)approved this decision. As Mr. Smith notes, should the UK legalize assisted suicide and Marie Rogers becomes depressed about her circumstances, there would be no problem with her obtaining the drugs to kill herself. That is, after all, the cheaper course. This is exactly what happens in Oregon--which rations some treatments for Medicaid patients.

I have heard health providers argue for a single payor system such as exists in the UK and Canada. Contemplate this part of the story linked by Wesley J. Smith,

Despite health officials' contention that decisions about treatment are based solely on clinical effectiveness, critics contend that with drugs growing ever more expensive, cost has become an increasingly important factor. They also say patients are at the mercy of the so-called postcode lottery, in which treatments are available in some postal zones but not others

So, care is rationed on the basis of money and postal zone? Who's to say that someday it couldn't be rationed on the basis of political or religious affiliation?

Wednesday, February 01, 2006

Haleigh Poutre is still not Safe from being Dehydrated to Death

Why? Read this column by Wesley Smith. For a preview:

How can this be? The simple answer is that tube-supplied food and water — often called "artificial nutrition and hydration" (ANH) — has been defined in law and in medical ethics as an ordinary medical treatment. This means that it can be refused or withdrawn just like, say, antibiotics, kidney dialysis, chemotherapy, surgery, blood pressure medicine, or any other form of medical care. Indeed, removing ANH has come to be seen widely in medicine and bioethics as an "ethical" way to end the lives of cognitively disabled "biologically tenacious" patients (as one prominent bioethicist once described disabled people like Terri Schiavo and Haleigh Poutre), without resorting to active euthanasia.

The fact that Haleigh is conscious and handed her State guardian a block upon request, when he finally bothered to visit her, makes no difference under the law allowing such withdrawal...

Which brings us back to poor Haleigh Poutre: Until and unless ANH is recognized as a unique category of care to be governed by its own rules for determining when and whether sustenance can be withheld or withdrawn, Haleigh remains very much at risk. After all, her doctors could still conclude that she will not improve. They could still recommend to guardian Harry Spence that he withdraw her food and fluids lest she grow up profoundly disabled. Spence could still agree that an early death is better than a longer disabled life and ask the courts to sanction her dehydration. The juvenile court could promptly hold a new hearing in which the judge would undoubtedly be told by a bevy of "expert witness" bioethicists that dehydrating this child to death would be ethical and morally appropriate even though she is conscious. The court could still order her to die slowly, over two weeks, of dehydration despite her being awake and aware. And the supreme court of Massachusetts could still give final approval to the decision. Such is the sad state of medical ethics and the law in the United States of America.