Hypothetical situation regarding termination of life support

[chimpy the poopthrower]

Okay, we've all had plenty of discussion on the Schiavo case. And there is also the case of the child in TX with a normally fatal condition who was just removed from life support against the wishes of his mother: http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=102x1316896
That case hasn't had quite as much attention on DU, but those who did comment on it seemed to feel, by and large, that the hospital did the right thing. I agree.

However, it's started me thinking about a hypothetical situation that is inspired by, yet different from, both those cases. Here goes: suppose someone enters a condition of having no consciousness, no medical hope by any realistic standards, but can be kept alive on life support indefinitely. This could describe either an infant born into the condition, or a "normal" person who came into the condition through illness or injury. So it would (according to most) definitely apply to Terry Schiavo after her cerebral cortex had completely deteriorated and arguably even before that point. It does not, I believe, apply to the infant in TX who had consciousness and was actually suffering physically because of his condition.

Here's the second part of this hypothetical situation: suppose the guardian or next-of-kin of this person wishes to continue life support for this person indefinitely. With an infant, the parents would normally be the ones to make healthcare decisions. In the case of someone like Terry Schiavo, imagine there is no disagreement among family members and no evidence of the person's wishes one way or the other. All the person has is his/her next-of-kin (spouse or parents) to make that decision based on their own beliefs. In this case, they believe it is in the person's best interest to be kept on life support indefinitely.

And here's the third part of the hypothetical: suppose the parents/spouse (or whoever the next-of-kin is) of the person on life support cannot afford to pay for the expense of that long term care. Which means that, one way or another, society will have to bear those costs.

Now here are the questions I'd like to hear people's opinions on:

1. Should cost of care (when borne by society) EVER be a factor in deciding whether to continue or discontinue treatment/care (not the ONLY factor, of course, just A factor)?

2. Cost considerations aside, should the decision makers for a person on life support ALWAYS be permitted the final say in whether or not to continue life support, as long as the person is not physically suffering (as the TX child was), and as long as the decision makers appear to be in their right minds? (The mother in TX appeared to be mentally incompetent; Terry Schiavo's parents, though many here disagree with their actions, don't seem to be mentally unfit in any legal sense.)

3. Does it make a difference whether we are talking about an infant, who could never make its own medical decisions, or an adult, who probably would have had some opinions but did not leave any indications of what those might be?

4. Does it make a difference whether we are talking about a state of complete brain inactivity or merely a state of deep unconsciousness, but one in which there is no real hope of recovery? (I'm assuming that latter situation is medically plausible; I don't really know. Perhaps there is always some hope of regaining full consciousness when the brain is still intact.)

5. Can a person with no consciousness or even no brain activity truly be considered to "suffer"? Of course there is no physical suffering, but does that mean that there is no harm done to the person by keeping him/her "alive"?

Some caveats: first, I don't have the legal background to know if there has already been a case fitting these exact requirements or what the ruling was if there was such a case. I also do not have the medical background to know if anything I posited is implausible from that standpoint. This is just a hypothetical situation as far as I am concerned.

Feel free to respond to any and all points that interest you and to disregard those that don't. Or even bring up some issues I did not address. I have some opinions on these questions myself, but I will not post them right away because I'm more interested in hearing what other people think.

[rfkrfk]

1. This is a 'who pays' issue

My understanding is,
the mother is free to take the infant to some other country,
for any reason.

[ayeshahaqqiqa]

2. the money factor

is apparent in many illnesses and deaths already-since we have no national health care, many many working people don't have health insurance, and put off going to the doctor/hospital until their conditions are so bad nothing much can be done about them.

I figure that, in the near future, if someone cannot pay for life support, the plug will be pulled. After all, Bush is doing his darndest to kill Medicaid and rip any semblence of a social safety net to shreads.

[izzie]

3. God this is a hard subject. So many odd cases

I once took a class in college where they talked about this. The world was keeping millions of people alive with not enough food to make them normal adults(half starved people with no educations or able to learn from childhood up)and wondering just what this would do to the world as it had been the first time the world had done this. What would it produce? People who studies that stuff were looking at it. I am not so sure we should keep these poor people on wires and tubes alive for years adults or children. I signed a paper for my self on that but with a child? My God who could even want to think about it.

[zalinda]

4. Okay, a little harsh here

but, I think if they aren't conscious and without brain activity, you should not keep them on a ventilator, the same goes for a feeding tube. If the guardians want to take on the expense that is fine, but the state should never. It would cost probably a million a year to take care of this "person". That million could pay for the care of thousands of people who contribute to society, or will in the future. It's the greatest good for the greatest number. Keeping a "person" "alive" just so their body is there is a religious mumbo-jumbo thing.

Have you ever seen someone in this state? I have, and it's not a pretty sight. It was a baby, who spent his entire "life" in an isolet, which came to about 9 mos. He cost a million dollars, and that was in the 70's. We paid for him, because his parents were poor Latinos in Calif, who would not remove the feeding tube. And yet, there was another little guy there who had been born to a drug addicted mom, who lived about the same time, and probably cost the same. He was born with too little intestine, but he was interactive and there was a chance that if he lived long enough, his body could be fixed. If you only had 1 million, which of these 2 babies would you save?

These are the choices we have to make in a society. It should always be the greatest good for the greatest number when it comes to government. We do make exceptions, but as money dries up for the poor, there will be less and less exceptions.

zalinda

[elehhhhna]

5. Court in Houston found last week that ABILITY to PAY plus

poor prognosis = pull the plug. They specifically cited ability to pay as a factor in the decision.

Slippery slope, guys.

[RememberTheCoup]

6. That post deserves a longer reply, but I'll make a couple points anyway.

First, no one favors using financial considerations as a basis for medical decisions. But unless society is willing to commit to fully funding all levels of healthcare, that is the reality. In emergency situations, patients must be "triaged" so that the worst off get treated first. In that case it is the staff that is the limited resource. In other situations it may be money that is the limited resource. We either have to say money is no object and we will pay whatever it costs or we have to draw the line somewhere and say that after that it is up to the patient's family to find the funds. And that must be true not only in cases where we generally agree that there is no good reason to provide care -- such as with a person who has no brain activity and no hope of getting better, but even in cases where most would agree that healthcare SHOULD be provided. Without unlimited funds, we have to start cutting services from the bottom -- the bottom being what is least necessary even if helpful.

As to whether a person who has no consciousness can "suffer," I say yes. In this society (and most others), we afford rights even to the dead. We make it a crime, for example, to dig up and defile or mutilate a corpse. We do that because we wouldn't want that happening to ourselves or our loved ones even in death. And many of us would not want to "live" as Terry Schiavo has, even while we acknowledge that she has no awareness of what is happening to her and is not really in any discomfort. There is also a religious angle. Many people have certain opinions about how they want their remains to be treated that stem from their religious beliefs. They may want to be buried within a certain time frame or with certain organs intact or with other requirements. So, yes, it is possible to harm a person even in death or a state of unawareness by not doing what that person would have wanted in life. It's like a contract the living make with each other.

[chimpy the poopthrower]

7. No one is interested in this?

:shrug: