A recent editorial in the British Medical Journal has pro-lifers up in arms over an ethicist's suggestion that keeping some patients alive would lead to depleting "severely resource limited healthcare services." The ethicist authoring this piece states that it would apply to life-support for patients who may have previously expressed not wanting the life-extending services.
Raanan Gillon, emeritus professor of medical ethics and former chairman of the Institute of Medical Ethics, writes in the British Medical Journal that a 2011 court decision in Britain regarding a brain dead woman whose family wanted to take her off life-prolonging resources but were denied is a ruling that "distorts healthcare provision, healthcare values, and common sense."
More specifically, the case decided in September 2011 ruled that the woman who had been kept alive through a feeding tube for more than eight years would not be given the "right to die." The Guardian reported at the time that the family of the woman, legally referred to as "M," had requested she be taken off the supply of nutrients and water being given to her, but the high court decided despite the "number of negative aspects" in M's life, she also had some "positive elements."
Judge Justice Baker said in the precedent-setting ruling that he "[accepted] the evidence of the carers," but her life is "not without pleasures, albeit small ones." Acknowledging the support of the family and supposing their distress at his final decision, Baker still ruled that M's current life state would not justify withdrawal of life support.
Gillon is writing that Baker's ruling is evidence of the "sanctity of life law [going] too far."
In the prominent medical journal, Gillon expresses in his editorial two aspects of Baker's judgement that he considers "profoundly disturbing." He first calls out a couple choice quotes from Baker's 2011 ruling:
[...] the judge emphasised that in deciding whether such withdrawal would be in these patients’ best interests it would “be wrong to attach significant weight” to their previously expressed values, wishes, and views unless these had been expressed in a legally valid and applicable advance decision. What should be given great “though not absolute” weight was the sanctity of life. The judge said (paragraph 230), “[given] the importance of the sanctity of life, and the fatal consequences of withdrawing treatment, and the absence of an advance decision that complied with the requirements previously specified by the common law and now under statute, it would in my judgment be wrong to attach significant weight to those statements made prior to her collapse.”
What first concerns Gillon is not honoring with "significant weight" the wishes of the patient before they entered this compromised condition. Secondly, Gillon calls out the ruling for implying that "all decisions about starting or stopping life prolonging treatment [...] should be brought to the Court of Protection" if the patient is in a minimally conscious state. Gillon expounds further on this point saying that he sees this ruling as implying in future cases that if a patient in a "minimally conscious state" or higher who had not written a valid statement to avoid any life-prolonging treatment, then their case would need to go to court before withholding any treatment that would extend life.
Ultimately, Gillon believes the judgement by Baker "[threatens] to skew the delivery of severely resource limited healthcare services towards providing non-beneficial or minimally beneficial life prolonging treatments including artificial nutrition and hydration to thousands of severely demented patients whose families and friends believe they would not have wanted such treatment."
It is this phrase that pro-life sites and supporters have quickly picked up on. LifeSiteNews, in its article titled "Dehydrate dementia patients to death to save money: British Medical Journal editorial", reports Anthony Ozimic with the Society for the Protection of Unborn Children saying Gillon's perspective is similar to that of eugenics:
“What is particularly disturbing about Professor Gillon’s opinions is that he is judging certain disabled people as having lives unworthy of life, balancing those lives against the needs of other patients and seeking to justify killing the disabled on the grounds of rationing,” Ozimic told LifeSiteNews.com.
“Such a utilitarian calculus is in substance no difference to the calculus made during World War II by the German authorities: that the disabled should die so that wounded soldiers could live. In any case, assisted food and fluids are basic nursing care, not futile medical treatments.”
LifeSiteNews also writes that the opinion held by Gillon, however "shocking," is actually one held by many mainstream ethicists.
Peter Saunders, a former general surgeon and CEO of Christian Medical Fellowship, writes on his blog (via National Right to Life News) that Gillon is "very selective" with the facts he calls out from M's case. Saunders, who has previously followed M's situation, continues writing:
[...] M had some awareness of herself and her environment, some understanding of language, occasionally spoke, appeared to be able to appreciate some things that were said to her and responded to music. Although she regularly experienced pain, this was not constant or extreme, and her condition was stable. And unlike dementia patients, who are terminally ill, she had a non-progressive condition.
Gillon’s suggestion, that severely demented and brain-damaged people should be sedated, starved and dehydrated to death on the basis of their friends and relatives vague and contradictory recollections of ‘what they would have wanted’ would create a most dangerous precedent and place us on a very slippery slope indeed.
What do you think of the arguments? Would Gillon's position lead to a "slippery slope" where "severely demented and brain-damaged people" could be allowed to die through denial of treatment? Or, is the British court's decision, as Gillon sees it, simply driving resources toward patients whose condition many never improve and who may never have wanted it in the first place? Share your thoughts in the comments section below.
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