Patricia Codey and Elizabeth Ryan have an op-ed on the Betancourt case in today's The Record (of northern New Jersey). Codey is president of the Catholic HealthCare Partnership of New Jersey. Ryan is president and CEO of the New Jersey Hospital Association. Their organizations appeared as amici on the side of Trinitas Hospital. I comment on a few passages. My comments are bracketed and in red.
The question our society must confront is: Should health care professionals be required to use technology to prolong a dying patient's life when those interventions violate longstanding medical ethics and standards, while providing no relief or benefit to the patient?
[With respect to medical futility, there are almost no "medical ethics and standards," much less any longstanding ones. Therefore, the question Codey and Ryan pose is framed is impossible unless we also determine what constitutes a "benefit to the patient."]
What sets this current case apart from prior situations is the fact that it is asking the legal system to compel doctors, nurses and hospitals to act in ways that go against the medical standard of care and continue treatment where it can do no good.
[The hospital and its amici failed to establish that the treatment requested by the patient's surrogate in this case contravened the standard of care. Moreover, the phrase "do no good" is very subjective. Here, the patient thought that the requested treatment (dialysis) was "doing good." Again, we must demarcate, as a society, a line between worthwhile interventions and non-worthwhile interventions.]
How much care is the right amount of care? When do health care interventions — in the form of machinery and technology — become inhumane rather than heroic? What, in fact, is a death with dignity? These questions are deeply personal . . . . But these very personal decisions are now becoming a societal issue as well — one that will confront physicians and families again and again in the years to come.
[I agree. We will not reach consensus on answers to these questions. But we can devise mechanisms to resolve intractable disputes.]
New Jersey once again is in a position to be a leader in setting legal precedent that clearly and compassionately establishes a process that respects the dignity of dying patients. It is a process that must include the input of patients and their loved ones. We urge the court to accept this opportunity to set forth reasonable, responsible and compassionate procedures to be followed by physicians and hospitals when artificial health care interventions overrun the natural capacity of the human body and spirit.
[I agree. The heart of my disagreement with the hospital and NJHA and CHPNJ is the same disagreement that I have with TADA. I really do want the dispute resolution procedures to be fair and reasonable. Unfortunately, the proposal that NJHA and CHPNJ offered the court was neither.]
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