Covid Death in Texas
This article is published by BioEdge and is shared with permission via Creative Commons License for non commercial use. My thoughts will follow at the end of the article.
A Covid-19 death in Texas offers a dramatic demonstration of the opposite poles in end-of-life care.
Michael Hickson was a husband and father of five children and reasonably healthy until 2017, when he suffered permanent brain damage after a heart attack. He became a quadriplegic in need of continuous medical care. On May 15 he tested positive for Covid-19 and ended up in intensive care in an Austin hospital. On June 5 his wife had a conversation with an ICU doctor — which was recorded by one of her friends, and posted to YouTube with a transcription. It is disturbing.
The doctor told Mrs. Hickson that further care for her husband was futile and that, against her wishes, Mr Hickson would not be nourished, hydrated, or receive treatment for pneumonia.
“So as of right now, his quality of life — he doesn’t have much of one,” the doctor said.
“What do you mean? Because he’s paralyzed with a brain injury, he doesn’t have quality of life?” she responded.
“Correct,” the doctor replied.
Mrs Hickson asks who decides whether quality of life is not good. The doctor responds that it’s definitely not him, but the answer to the question about whether more treatment would improve his quality of life was no.
She asks, “Being able to live isn’t improving the quality of life?” He counters with the picture of Mr. Hickson being intubated for more than two weeks. But Mrs. Hickson also gets him to admit that he knows of three people who went through that ordeal and survived. She tells him that her 90-year-old uncle with cancer got Covid-19 and survived.
His response to this was less than tactful: “Well, I’m going to go with the data, I don’t go with stories, because stories don’t help me, OK?” Toward the end of the conversation, he says, “we are going to do what we feel is best for him along with the state and this is what we decided.”
On the following day, Mr. Hickson was moved to hospice care. According to Mrs. Hickson, there they “withdrew food, fluid, and any type of medical treatment” from him, and he died on June 11.
“He regained his personality, had memories of past events, loved to do math calculations, and answer trivia questions,” Mrs. Hickson said in an interview with The Texan. “Why are disabled people considered to have a poor quality of life?”
“This is not isolated,” Kimberlyn Schwartz, Texas Right to Life’s Director of Media and Communication, told The Texan. “Quality of life is a value judgment and is a decision that should be left to the family. This horrible ‘quality of life’ ethic is ingrained in many of our large medical institutions and patients and families need to be vigilant.”
Michael Cook, publisher of BioEdge.
What is Futile Care?
I have written before on every hospital having a futile care policy and your right to ask for it and read it. University of Michigans was published on line and I have a copy of it.
To require a hospital, health facility or agency that maintains a written policy that encourages or allows a health care professional to withhold or discontinue treatment on the grounds of “medical futility,” and applies this policy to the treatment of minors, to provide a copy of the policy to the patient, parent or legal guardian upon request. https://www.michiganvotes.org/2013-SB-165
“The termination of treatment, including life support systems, does not require documentation of death. In appropriate cases, the attending physician may terminate treatment or preclude some or all future treatment with an appropriate written order when the patient is not dead. Cessation of treatment of a patient declared dead does not require specific orders or procedures, nor does it require family consent.” (excerpt from U of M policy)
At this point, several important points need to be made about futile care:
1. Futility is not a medical determination; it is a value judgment. Treatment is refused based on “quality of life” judgmentalism and/or “cost-benefit” analysis.
2. Futility makes patient autonomy a one-way street. For years, we have been told that patients should state in writing what they want or don’t want in the event they become incapacitated. Futile Care Theory makes refusing treatment binding for patients who want to die, but allows doctors/bioethicists the final say over the care of patients who expressed a desire to live.
3. Futility strips from patients and families the power to make medicine’s most important health care decisions and give it to strangers:
4. Futile Care Theory is only the first step toward a coming duty to die. Think of Futile Care Theory as ad hoc health care rationing. Once Obamacare is up and running, centralized boards will create cost-benefit bureaucratic boards that could systemize Futile Care Theory into mandatory refusals or outright health care rationing based on patients’ quality of life. Indeed, rationing has repeatedly been endorsed by notable publications such as The New England Journal of Medicine and The New York Times.
Moreover, if doctors want a patient to die sooner rather than later, they should bear the strong burden of proof in order to prevail. After all, the point of Futile Care Theory is to impose a form of the death penalty. When in doubt, every benefit of doubt belongs to wanted life. John Wesley Smith in 2012. Source
Do you know what the hospitals policy is where you live?
If not, why not? Don’t you want to know how your loved one would be treated if they were admitted to a hospital with a serious injury or Covid Diagnosis?
I’ll leave you with a few other things to ponder….Michael Hickson was a Black man. Would it be great if BLM advocated for this man.
Michael Hickson was disabled. What is the National Council of Disability doing besides writing a letter on how shocked and sadden they were?
Praying for his wife and 5 children.