Suzanne Sataline has an article in today's Wall Street Journal, "Court Weighs Death Decision," reporting on the Betancourt case. It is pretty matter-of-fact, and serves as a basic summary of both the facts and of the nature of the dispute. But one quote caught my eye.
Sam Germana, vice president and general counsel for Trinitas, a 500-bed acute-care institution, said the hospital's ethics committee grappled several times with Mr. Betancourt's care plan. "Our doctors usually err on the side of doing anything,'' Mr. Germana said. "It's extremely rare when they say 'enough is enough, we're just keeping organs alive.' ''
First, the hospital never introduced, either at the trial or appellate levels, any documents or any testimony concerning either the operation of its ethics committee or what it did in this case. So, we do not know who is on the Trinitas ethics committee (composition, diversity). We do not know the qualifications of those on the ethics committee (competence). We do not know how the ethics committee works (procedures, bylaws). We do not have any minutes from the meetings in this case.
All we do know from the case is that the Trinitas ethics committee appears to have been under the thumb of the hospital CEO who wanted the very expensive, uninsured Betancourt out of his hospital. Still, the hospital, NJHA, and MSNJ now want the courts to defer to the decision of ethics committees. I think this is, in principle, a good dispute resolution model. But NJ ethics committees are just not ready for life-and-death power. Analogously, I'll hand over the keys to my new Porsche to the 22year-old valet. But not if he is visibly drink or stoned. The courts should not hand over decision making authority until responsibility has been demonstrated.
My second observation about Mr. Germana's comment is that I think it can fairly be restated as follows: "We usually don't under-treat patients here, we usually over-treat them." But both extremes pose risks to patients and society.
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