GESTIÓN EN SALUD PÚBLICA: BioEdge: Another controversy over futile care in Texas

sábado, 16 de enero de 2016

BioEdge: Another controversy over futile care in Texas

Another controversy over futile care in Texas

by Xavier Symons | 16 Jan 2016 |

Chris Dunn in hospital bed before Christmas

Medical ethicists have clashed over the death of Chris Dunn, a Texan man at the centre of an end-of-life care legal battle.

Dunn, 46, died late last month, following a year-long battle with apparent pancreatic cancer. Certain members of his family were petitioning a court to mandate the continuation of life-sustaining treatment. A medical ethics committee at Houston Methodist Hospital, acting on advice from one of Dunn’s doctors, deemed ANH to be inappropriate and decided to allow his doctor to discontinue life-sustaining treatment.

Some of the details of the case remain unclear. It is perhaps best merely to quote the differing opinions that have been offered following Dunn’s death.

In an essay in The Public Discourse earlier this month, paediatrician Phillip Hawley Jr. argued that the decision of the hospital to Dunn’s life-sustaining treatment was tantamount to ‘death by committee’:

“Having participated in many treatment discussions on behalf of terminally ill patients, I will readily acknowledge that patients and families sometimes have unrealistic hopes for a cure. However, acknowledging this possibility does not redeem a badly flawed law or vindicate a morally corrupt decision. In deciding to withdraw life-sustaining treatment from an alert and cognizant patient who so obviously wanted to continue living, the hospital and its ethics committee stole from him the two most fundamental rights enumerated in our Constitution: life and liberty.”

Hawley argues that there is evidence to suggest that Dunn was still capable of rational decision-making, and that, in any event, it was unjust for the hospital to attempt to override the wishes of his family members who wanted ANH to continue.

“Relative strangers with little or no knowledge of his values and beliefs weighed his “quality of life” and decided that he no longer deserved to live…

“On many occasions, I have watched anguished parents struggle to discern what is in the best interest of their terminally ill child—a child they have known since birth…But, somehow, we are to believe that these committee members were able to deduce existential truths about what was in Chris Dunn’s best interest?”

Dr. Beverly B. Nuckols, a family physician from Texas, and Deirdre Cooper, a public policy analyst at Texas Alliance for Life, penned a terse reply. Cooper and Nuckols suggest that, on the evidence available, it seems that the decision to discontinue Dunn’s ANH might have been justified. They take issue with what they see as the Hawley’s attribution of murderous intentions to the hospital staff and ethics committee.

“This is not simply a case of a hospital or a doctor versus the patient and his family. Rather, this is a case of an incapacitated patient who was terminally ill, whose parents disagreed about the best course of treatment, and whose doctors believed that life-sustaining treatment was causing suffering, as is plainly evident from court documents…

“It is plausible that the doctors had good reasons to believe that the pancreatic cancer was untreatable. They may have believed that attempts to maintain the status quo would be medically ineffective, would not save his life, and would increase physical pain and bodily damage while possibly hastening death…”

The case of Chris Dunn is another controversy caused by Texas’s Advance Directives Act (or futile care law), which allows doctors to discontinue life-sustaining treatment ten days after giving written notice if life-sustaining treatment is deemed futile.

- See more at: http://www.bioedge.org/bioethics/another-controversy-over-futile-care-in-texas/11716#sthash.TXP8yiKR.dpuf

In his State of the Union address President Obama announced a cancer moonshot: an ambitious plan to cure cancer. "The same kind of concentrated effort that split the atom and took man to the moon should be turned toward conquering this dread disease," he said.

Oops. He didn’t say that. Richard Nixon did in his 1971 State of the Union address. “We want to be the first generation that finally wins the war on cancer,” then-Vice President Al Gore said in 1998. “For the first time, the enemy is outmatched.”

It’s not just the politicians who know how to cure cancer. Scientists make big promises as well. In 2005 the Director at the National Cancer Institute, Andrew von Eschenbach, said “Our plan is to eliminate the suffering and death that result from this process that we understand as cancer, and we are committed to a goal of doing so as early as 2015.”

That commitment was made only ten years ago and cancer is still the second leading cause of death in the United States.

It’s great to feel optimistic, but one has the feeling that promises like these are made to distract voters from other issues. “It’s a bit utopian at this point,” agreed Barrie Bode, a professor at Northern Illinois University and a 20-year cancer researcher, told MarketWatch. “It’s like saying we need to fix the economy once and for all. Right, like that’s going to happen,” he said.

However, if you are looking for a job in cancer research, now looks like a very good time.