The right to live or the right to let die?

In a story that has recently been brought to the attention of the Texas public by the group Texas Right to Live, a dying man whose treatment was determined as futile was taken off of said treatment, consequently ending his life. The use of this policy permitted by the Texas Advanced Directive Act (that has been in effect for almost thirteen years) is causing a stir with many pro-life individuals and groups who are calling for this act to be repealed.

In this specific case, Texas Right to Life director Elizabeth Graham has presented the story to the public in such a way that it would seem unnatural for someone NOT to demand that the act be repealed immediately. This is what I take issue with. Not because I’m against the right to life, but because this biased outlook ignores other factors that should be considered. This act has a purpose. While repealing it would satisfy our desire to feel we are doing the most for a person’s right to live, it would also have consequences. After all, acts dealing with matters as sensitive as life and death have been put into place for important reasons.

A more complete look at the story would entail a Houston man identified only as Willie, who went to the hospital with chest pains. The doctors diagnosed him with pneumonia and leukemia which he then underwent surgery and chemotherapy to treat. When a medical panel determined the treatments to be futile, the family was given an opportunity to find another health care facility that would take Willie in. When a facility was unable to be found within the 10 days allotted by the act, life sustaining treatments were ceased for Willie and he then passed from lack of nutrition and dehydration.

Graham’s pro-life rendering, which is quoted in many different reports of the story, is a heavily emotional one that stresses the heart wrenching aspects of it. She claims that the panelists decided that his life was not worth living and they disregarded the family’s pleas to continue treatment. It is easy for this issue to seem insensitive when it is looked at on this up-close personal level, and understandably so. It’s a natural human reaction to feel compassionate about a fellow human’s life; however we also need to look at the bigger picture from an objective standpoint.

The Texas Advanced Directive Act is a document explaining protocols to follow regarding issues such as patients’ medical and life wishes, who will make medical decisions if the patient is unable to speak for themselves, and in this case, the procedure to follow if doctors decide treatment can no longer save the life of the patient. This section is titled Procedure If Not Effectuating a Directive or Treatment Decision. Briefly, if a doctor feels that a patient has no chance of a meaningful recovery, he will discuss this with the patient’s family. If the family does not agree and wants more time, the doctor can refer the case to an ethics committee (or with a slightly more negative connotation, a death panel). The family is given a 48 hour notice of the committee meeting, may attend the meeting, and is afterwards given a written explanation of the decision that is made. If it is decided to discontinue treatment, the family is given 10 days to find another health facility to transfer the patient to. At the end of the 10 days, life sustaining treatment is discontinued. The details for this section can also be found here.  

These decisions are made only when the patient is terminal and there is no chance of recovery. The only options are to continue keeping people alive with machines or to withhold treatment. Stories that claim that doctors deem a person’s life as “not worth living” suggest that the doctors simply do not want to put in the effort to increase the chances of survival. If the doctor is at this point, there are no chances of survival left outside of the hospital. It’s true that continuing life sustaining treatment when the body cannot recover will extend life, but the body will start to shut down in other ways, only lowering the quality of life until death comes.

I believe the Texas Advanced directive act should not be recalled for three reasons. The first of which is what has previously been stated. Keeping a person alive through medical means when they could not survive otherwise will only diminish the quality of time that is left. It often becomes more painful and debilitating and organs and systems shut down or become out of sync. Operations or other treatments used in response become even higher risks. Many people who die in hospitals today after trying every treatment to stay alive are unconscious or are out of touch with the world because of strong doses of pain relievers. A second reason is that the price of these treatments that have been deemed by professionals as futile are extremely costly to the economy and medical field. The Centers for Medicare and Medicaid Services estimates that 5% of those who die each year take up 30% of the $446-billion annual Medicare budget. And about 80% of that money is spent during the final month. This money is spent on mechanical ventilators, resuscitation and other aggressive care. More often than not, the aggressive steps taken to save someone’s life are futile. Also, as new treatments and procedures are developed, they get more and more expensive. As harsh as it sounds to turn a life and death situation into a financial matter, is it a problem, and a growing one at that. Something needs to be done to counter it. And finally, the citizens of the United States do not like to give up on living. There is a distorted sense of vitality amongst people. Generally, people don’t want to accept mortality and will do everything to ‘fight’ the ‘battle’ to overcome it. This becomes a problem when it comes to situations as Willie’s. Death is inevitable. Everyone knows it, but nobody wants to accept it. With this mindset, focus is put on unrealistic goals and not comfort and closure. By recalling this act, these beliefs are reaffirmed within people.

It is most important that people accept death as a part of life. Nobody wants to lose out on their own time or lose ones they love, however that isn’t in our control. And trying to take control just isn’t reasonable. The costs of finances, time, and emotions alike are simply too high.  Doctors who make these decisions are doing their part to help these patients. They can no longer successfully treat them and when that is the case, sometimes the best thing to do is for them to prevent any further harm. Groups such as Texas Right to Life may intend to help, but stigmatizing policies that are in place to facilitate one of arguably the most difficult times in life is only damaging.