The subject of how best to honor and care for those facing death due to terminal illness or old age has always been controversial. As talk of "death panels" and "rationing" stirs debate over the government's proper role in health care, two new studies funded by the National Institutes of Health are lending new weight to the argument that, when it comes to providing end-of-life care for the elderly and terminally ill, sometimes less is better. The studies, featured in the New England Journal of Medicine, document how certain medical therapies implemented in the final months of a patient's life often cause emotional and physical stress and pain, effectively negating any positive benefits associated with such treatments.
However, those worried that a government takeover of health care will result in health care rationing in keeping with Dr. Ezekiel Emanuel's "complete lives" theory view these studies with alarm-and for good reason. In a culture where "quality of life" is increasingly viewed as the predominant justification for abortion, assisted suicide, and even infanticide, there is a legitimate concern that these kinds of studies will be used by the government to advance policies that endanger society's most vulnerable members.
The pivotal question is not whether difficult end-of-life decisions must sometimes be made, or whether-as the NIH studies indicate-sometimes the best decision is to forego heroic measures in favor of simply keeping a patient comfortable in his or her final days. The traditions of hospice and palliative care, for example, both work to keep dying individuals in a state of dignity and comfort without resorting to extraordinary, and ultimately futile, measures. The question is who should make these decisions.
Government-run health care has ominous implications because it supplants individual doctor-patient relationships with generalized protocols crafted by bureaucrats who have no way of accounting for the particular needs of the human beings affected by them. These protocols are often drafted with cost-cutting goals and resource management in mind-not the criteria most want at the top of the list when it comes to life and death medical care.
At many hospitals and nursing homes in the United Kingdom, for example, elderly patients deemed close to death are placed in a "care pathway" designed to ease the dying process and conserve medical resources. Once it is determined that a patient is near death, life sustaining fluids and medicines are withdrawn and the patient is placed under heavy sedation. As bioethicist Wesley J. Smith describes it, "the Pathway misuses the legitimate treatment of palliative sedation, and mutates it in some cases into a method of causing death, known as terminal sedation. This means that sedation is sometimes administered, not because the individual patient actually needs the procedure, but because he or she has been reduced to a category member, and that's how members of the category are treated." When this kind of one-size-fits-all approach is employed, casualties are inevitable. One man has already lost his life due to the misapplication of England's bureaucratic approach to end-of-life care.
At the other end of life's spectrum, last month a woman in England was forced to watch her premature infant struggle to survive without medical care for hours before finally dying on the delivery room table. The reason? Doctors told the new mother that "national regulations" prevented them from providing medical care because the baby was born two days too early to qualify for life-saving measures. In Canada, the government recently decided to end funding for a medication that adds an additional nine months to the lives of colon cancer patients. Why? "Clinical" evidence suggested that the additional months of life were not worth the cost of the medication.
In each of these situations, end-of-life decisions were made without the input of, and sometimes against the explicit wishes of, the individuals involved. These treatments are not being employed as one option among many-they are being imposed uniformly as a matter of policy.
Few would deny that some measure of reform is needed in the healthcare arena. Our country is on the threshold of a veritable Senior Tsunami; an enormous age wave is coming. As America increasingly becomes a mass geriatric society, large numbers of the elderly will soon need acute and long term care. Yet, even as the demand for medical care is increasing, Medicare funds are in short supply, and something's got to give.
But if our leaders in Washington are unable or unwilling to come up with a uniquely American solution to this problem, and if the looming healthcare crisis continues to be exploited by leaders on the Left simply as a means to a greater ideological end, there is good reason to fear that the cold comfort of England's "care pathway" approach to end-of-life care may be coming soon to a hospital near you.