Removing Life-Support is NOT euthanasia.

This article was published by National Review online on January 4, 2017.

Wesley Smith

By Wesley Smith

Stopping life support so natural death can come is a normal part of health care. We all have the right to refuse medical interventions even if it is likely to lead to death. As the great late bioethicist Paul Ramsey put it when he led the movement in to obtain that right, not forcing tubes and drugs into an unwilling person is to treat the “patient as a person.” 

Moreover, in the 1976 Karen Ann Quinlan case, New Jersey’s Supreme Court ruled that removing a respirator at the request of an unconscious patient’s parents is not killing. It is notable that after her respirator was removed, Quinlan lived another ten years. 

As they always do, the euthanasia movement attempted to harness the right to refuse treatment and morph it into a right to be made dead. That gambit was refused unanimously by the U.S. Supreme Court in 1997 (Vacco v Quill). There are factual and moral distinctions between dying after refusing life support–such patients don’t always die and the death is natural–and giving a patient poison to make her dead. 

Now, Dave Adox, a New Jersey man dying of ALS wants to remove his ventilator so that he can die. That’s his right. 

But he wants to do it in a hospital so he can donate his organs. Hospital lawyers are saying no, worried that it might be construed as an assisted suicide. From the MedCity News story:

University Hospital has declined several requests for comment, but Bach said the hospital’s attorneys were concerned about liability.  

“The legal issue is: What is euthanasia?” Bach explained. “Are you killing a patient by taking him off a respirator that’s keeping him alive?” 

But that’s a long settled question under the law. It isn’t. 

The lawyers are clearly squeamish because of the organ donation request. That is the real concern, not that the death would be euthanasia. 

They have a point. Adox’s case represents an expansion of what is known as “donation after cardiac death” (DCD) protocol, during which life support is removed, and then three minutes after death cardiac arrest, death is declared and the organs are procured. 

Such protocols are controversial for several reasons too lengthy to get into here. But if performed properly, they are definitely legal. 

When that protocol was first developed, bioethicists promised it would be strictly limited to people with catastrophic brain damage. Of course, such public policy promises are made to be broken, the assurances given merely to convince a wary public to go along. That is why bioethicists promising strict guidelines should never be believed. 

The principle should be judged, not the promised strict limitations that soon evaporate. 

This case represents just such an expansion. But the principle is sound. 

I see no reason to preclude Adox from being an organ donor. His disease is at a very advanced stage when refusing life-extending treatment is common and uncontroversial. He has a right to refuse treatment. He is not being killed for organs. 

But if he doesn’t die after the ventilator is removed, no action should be taken to make his heart stop. That would cross the crucial line into killing for organs–as happens in Belgium and the Netherlands–which would violate the law and crucial moral principles that vital organ donors be dead before their gift of life is received.

Who has the right to decide when to withdraw medical treatment.

Today, there are two court decisions from two countries both dealing with a similar question, that being, who has the right to decide when to withdraw medical treatment.

 

The first case, decided by the Consent and Capacity board in Ontario, concerns a 90 year-old man, referred to as GS, who is a survivor of the Nazi Holocaust, was a victim of a car accident and has been in coma for the past 20 months.

An Ottawa hospital was given the right, against the wishes of the family, to withhold aggressive measures, but the hospital did agree to continue life-sustaining measures until he died a natural death.

The Ottawa Citizen reported that:

GS’s daughter, who had often been in disagreement with medical staff about her father’s hospital care, opposed the plan.

GS’s daughter and three grandsons all testified that although GS could not speak, he recognized them during visits and showed signs of happiness. She suggested her father did not react the same way with doctors and nurses because he feared they were trying to kill him.

The family described GS as a religiously observant Jew, a disciplined man with a strict health regime and a fighting spirit. GS’s daughter noted that her father, an immigrant from Romania, had successfully recovered from hip surgery and two heart surgeries before his car accident. (He worked as an engineer in Montreal before retirement.)

The board also heard about the existence of a power of attorney document signed by GS in April 2010. In it, GS expressed his wish that his life not be prolonged under certain circumstances: if he’s in an irreversible coma; if he’s terminally ill and life-sustaining procedures will only delay his death; or if the burden of a treatment outweighs its expected benefits.

First: This is not a case of euthanasia. Heroic measures and burdensome testing is being withheld but life-sustaining treatment, such as hydration and nutrition are not being withheld from GS. In other words, this decision is not attempting to withdraw treatment, but rather withhold treatment that is deemed unnecessary.

Second: If the family is upset by the decision they should appeal the decision to the Ontario Court of Appeal.

Third: The question of who has the right to decide is significant in these cases because doctors are required to obtain consent, in Ontario, before they can implement a treatment plan.

The problem that the family may have in this case is that GS has signed a Power of Attorney document that basically states that the doctors medical treatment decision is acceptable. Whether or not someone intends what their Power of Attorney document states, once it has been signed, it is a legal document.

People who are concerned about these issues need to order the Life Protecting Power of Attorney for Personal Care from the Euthanasia Prevention Coalition.

The Second case is that of a child in the UK, known as baby X, who is believed to be in a coma. Baby X had a traumatic accident in May 2012 that is believed to have caused an irreversible brain injury.

Justice Hedley decided that it was appropriate to withdraw the ventilator from Baby X and that treating  Baby X with palliative care was an appropriate decision, even though this decision is against the consent of the parents. Justice Hedley also decided that life-sustaining treatment, presumably hydration and nutrition, should be continued indefinitely.

First: This is not a case of euthanasia. This is a very difficult case to access, because Baby X is likely to die after the ventilator is withdrawn but Baby X may survive and continue breathing. Hydration and nutrition appears that it is not being withheld from Baby X.

Two: The judge did agree to a plan of treatment, that being palliative care. I am not sure whether the parents have consented to this treatment plan but it is clear that they are not consenting to the withdrawal of the ventilator.

Third: The question of who has the right to decide is paramount in this case. The judge has provided consent to a treatment plan against the consent of the parents. Baby X is unable to consent to treatment therefore the wishes of the parents is normally upheld as the substitute decision makers.

It is important to note that doctors are not obligated to provide medical treatment that the doctor considers to be futile, burdensome or outside the parameters of the normal medical standard.

These cases clearly show that a tension exists between the right of the physician to refuse to provide treatment, that the physician deems to be futile, and the rights of a person to receive treatment, that is believed to be beneficial, or respects the faith of the person or the substitute decision maker.

The contention is whether or not the parents preferred treatment plan is in the best interests of Baby X. Since the death of Baby X is the likely result of the withdrawal of the ventilator, therefore, the wishes of the parents should be respected, but limited. The doctors cannot be forced to provide treatment that is considered futile.

Justice Hedley should have decided to limit his decision to withholding aggressive medical treatment, in a similar manner as the Ottawa decision. Consent would not be given when or if Baby X required further medical intervention. Natural death would then occur without infringing upon the rights and religious beliefs of the parents who only wish to care for their child.

Media incorrectly defines act by German doctors as euthanasia.

A recent article in the United Press (UPI.com) incorrectly defined euthanasia.

The article titled:German court clears euthanasia docs is wrong.

The article stated:

Paul Schoenle, the former head of neurology at a rehabilitation center in Magdeburg, Germany, and physician Frantisek Kovacic were cleared of charges Monday after a Hamburg court determined they had acted ethically in the case of Briton Timothy Sanders, the German broadcaster Deutsche Welle reported.

Schoenle had been charged with manslaughter while Kovacic was charged with being an accessory to manslaughter after they allowed the brother of the fatally ill and paralyzed Sanders to turn off his breathing apparatus in May 2004, the broadcaster said.

Sanders had been paralyzed since an accident in 2002 and could not breathe unaided. He died minutes after his brother Paul turned off the machines in a case of euthanasia, prosecutors said.

"The court found that the doctors behaved correctly both ethically and medically," a court spokeswoman said following the ruling, which determined that Sanders had already been terminally ill when his life was ended, Deutsche Welle reported.

According tot he article Dr. Paul Schoenle turned off the respirator that enabled Timothy Sanders to breath. But, turning off a breathing machine is not euthanasia.

Sanders died a natural death that resuled from his medical condition. Nobody denied Sanders oxygen, it was available, but due to his medical condition, he was unable to breath effectively. If Schoenle had put a bag over his head to deny him oxygen, then they would have caused his death.

There is a difference between killing and letting someone die. Sanders was not killed but let to die.

Euthanasia is the intentional cause of death, whereby the person dies from the action or omission that is done to cause death. When a person dies from a medical condition, then it cannot be euthanasia.

Since I do not know all the facts of the case I can only say that the charge of manslaughter was probably also incorrect.

UPI.com got the story wrong, the real question that the German court decided was whether or not their act was ethically correct or not. The court found that the doctors behaved correctly both ethically and medically. If there is any conflicting evidence in this case, I would certainly like to hear it.

Link to previous article about Killing or Letting Die:
http://alexschadenberg.blogspot.com/2008/07/killing-or-letting-die.html

Link to the article from the United Press International:
http://www.upi.com/Top_News/2008/12/23/German_court_clears_euthanasia_docs/UPI-46571230058513/