Bridget Williams on Betancourt v. Trinitas Hospital

Bridget Williams has a post at the University of Oxford's Practical Bioethics blog.  She provides a reasonable review of the case and then defends what I and others have criticized: the hospitals's motivation by costs.  Williams grounds her defense on both stewardship and triage rationales.  I agree that those can both be valid bases for refusing treatment.  But there is no evidence that either was applicable in this case.  

Williams uses many different terms to describe Betancourt's treatment:  (1) "inappropriate medicine," (2) "bad medicine," (3) "no hope of improvement," (4) "impossible goals," and (5) "little or no capacity to benefit."  I am not sure any of these terms helps very much to advance the analysis.  The family wanted dialysis to keep Ruben Betancourt alive.  Dialysis could and did achieve just that.  Consequently, the goals were not "impossible."  The family did hold out "hope of improvement."  And while unlikely, improvement was at least possible.  Whether the medicine was "inappropriate," "bad" or offered "benefit" is unknown because we have no tests for determining any of these value-laden terms in the fuzzy gray area where this and most futility cases lie.  

Finally, Williams writes: "In the United Kingdom patients and surrogates do not have the right to demand treatment that a doctor believes is not in line with standard medical care and is not in the patient’s best interests." (emphasis added)  This is a little misleading because the ultimate test is not the doctor's "belief" about best interests.  Pursuant to the 2004 ECHR ruling in Glass, the court will determine whether patients and surrogates have the right to demand certain treatment.