The Duty to Die: Scouting the Next Pro-Life Battlefield

by Deborah Sturm - March 23, 2008

Reprinted with permission.

In an article in the Washington Post last fall, Charlotte F. Allen offered her sneaking suspicions about American healthcare. Addressing the issue of the "living will," she wrote:

When I contemplate the concept of "dying well," I can't avoid the uneasy feeling that it actually means "dying when we, the intellectual elite, think it is appropriate for you to die."

The Hastings Center Report, regarded as the world's most prestigious bioethics journal, recently published "Ending the Life of a Newborn: The Groningen Protocol" by Hilde Lindemann and Marian Verkerk, which promoted infanticide for babies deemed to have a poor "quality of life." The authors, while admitting that making such judgments seems "arrogant," nevertheless assert that they "cannot be evaded." Furthermore, they condone "lethal preemptive strikes" for "suffering that will take place in the future." The authors continue:

[We] agree… that actively ending a life can sometimes be more humane than waiting for the person to die, and that in the desperate cases where death does not come of its own accord to end unendurable suffering, the morally right thing to do is to summon it.

The views of the Hastings Center Report have made their way into American healthcare, confirming Allen's uneasiness. They have been flying quietly under the public's radar screen in the form ofmedical "futility" policies.

Briefly, physicians, often with the input of ethics committees, decide when human lives should be terminated based on how they view the quality of life of patients. If they regard one's quality of life insufficient to continue treatment – or, if they speculate that one's quality of life would be subpar if they awoke from a coma – treatment is labeled "futile."

To be clear, treatment is denied not because the patient is expected to die; rather, the providers fear the patient might live. Thus, not only are many persons now denied a natural death, but some might even be denied a chance to livea normal life.

Not surprisingly, then, the hallowed "right to die" has evolved into a "duty to die," and a caste of disposable persons has essentially been created.

This modern concept of futility poses grave danger even to patients who specifically request resuscitation efforts in the event of cardiopulmonary arrest. Indeed, another issue that has bubbled to the surface is the "slow code" – hospital slang suggesting a leisurely walk to the bedside – wherein a code team declines to pursue aggressive measures to resuscitate a patient. In effect, they stage a response that is delayed to the point where the patient's chances of survival are greatly minimized. When the patient dies, the staff document that "all measures were taken."

The rationale for such a response might be that the patient is "severely terminal" or "demented," and resuscitation is regarded as "futile," as the team speculates that the person would have an inadequate quality of life if he were revived.

This brave new world of pragmatic, utilitarian medical ethics where perception is reality and the ends justify the means eclipses the patient's inherent worth and dignity. And if universal healthcare is implemented – something that seems more of a reality today than in the early days of the Clinton administration – Americans who face a catastrophic illness or injury will be at even greater danger of becoming casualties of the healthcare industry.

The rationing of health services is already a reality in America. Adoption of the "quality of life" ethic was deemed necessary by progressive forces as the instrument of its facilitation. And according to the Robert Powell Center for Medical Ethics, "The laws of all but ten states may allow doctors and hospitals to disregard advance directives when they call for treatment, food, or fluids." The stage is now set for extensive rationing, if the government were to take control of healthcare – as is the case in countries such as Great Britain and Canada.

Some steps can be taken to minimize the risk of becoming a casualty of quality of life and futile care judgments – one is to sign a protective advance directive, as opposed to a living will. The National Right to Life Committee, for example, features the "Will to Live," and the International Task Force offers the "Protective Medical Decisions Document."

The Terri Schindler Schiavo Foundation has been working to establish a network of pro-life healthcare providers who will accept patients whose treatment has been labeled futile. The Foundation has also been effective in their assistance to other right-to-life organizations in bringing to light the cavalierpolicies of some hospitals.

In 2006, the Foundation helped Texas Right to Life expose St. Luke's Episcopalian Hospital in Houston after they decided to terminate the life-sustaining treatment of Andrea Clark. Clark, a Catholic, informed her family she wanted to die naturally. However, she was threatened with euthanasia after the hospital's ethics committee arbitrarily decided that continued treatment was futile. Mounting public pressure forced them to retract their decision, and Clark was finally allowed to die a natural death.

The public overwhelmingly supports patients' choices for life-preserving measures, even when healthcare providers think their quality of life is poor. With public opinion on the side of patients in this regard, the press can be instrumental in shining light on the shameful behavior of a healthcare facility. However, as Dorothy Timbs, legal counsel of the Robert Powell Center for Medical Ethics, points out, "[It] is equally important to work for legal reform so that your choice for life will be honored."

Deborah Sturm is a registered nurse and the Secretary for the National Association of Pro-Life Nurses.