Reasoning through the rationing of end-of-life care

Jan 19, 2010

Acknowledging that the idea of rationing health care, particularly at the end of life, may incite too much vitriol to get much rational consideration, a Johns Hopkins emeritus professor of neurology called for the start of a discussion anyway, with an opinion piece featured in this month's issue of the Journal of Medical Ethics.

In the January article, John Freeman, M.D., Lederer Professor Emeritus of Pediatric Neurology and a faculty member of the Johns Hopkins Berman Institute of Bioethics, asks the Obama administration to consider rationing end-of-life care as an initial step towards .

The piece, "Rights, Respect For Dignity And End-Of-Life Care: Time For A Change In The Concept Of Informed Consent," starts with the premise that futile and expensive care at the end of life is widespread, that it has been a major contributor to the increasingly unaffordable cost of healthcare and that the nation is unable to provide it equitably to all.

He goes on to say that while administering such care—as ordered through a living will, next of kin or parent—should be respected, he advocates that the ethical imperatives of "patient autonomy" and "surrogate autonomy" (passing responsibility for decision-making to next of kin when a patient no longer is competent to make his own decisions) should be weighed against the societal impact and costs of such care in futile circumstances.

"Perhaps when surrogate autonomy and the ethical principles of beneficence"—the duty to do more good than harm—"compete with the utilitarian principle of doing the greatest good for society, the family be given a 'nudge' towards comfort care only," Freeman suggests in the piece.

"There must be few situations more undignified, more dehumanizing or more humiliating than lying in bed, incontinent, tube fed, with or without a respirator, unable to speak or to relate to individuals or the environment," Freeman says, factors that more surrogates may want to give more weight.

Rationing and providing only comfort care should be considered not just at the end of life for adults, Freeman maintains, but also in instances of extremely premature births. He cites studies showing that intensive care for infants born at 22-23 weeks resulted in more than 1,700 extra days in intensive care, with less than 20 percent surviving. Of those 20 percent, less than 3 percent survived without profound impairment that required expensive interventions.

Explore further: French court rules 'no error' by German body over faulty breast implants

Related Stories

Who gets expensive cancer drugs? A tale of 2 nations

Dec 14, 2009

The well-worn notion that patients in the United States have unfettered access to the most expensive cancer drugs while the United Kingdom's nationalized health care system regularly denies access to some high-cost treatments ...

Patients being discharged against medical advice

Mar 09, 2009

When patients choose to leave the hospital before the treating physician recommends discharge, the consequences may involve risk of inadequately treated medical conditions and the need for readmission, according to a review ...

Recommended for you

Drug and device firms paid $6.5B to care providers

Jun 30, 2015

From research dollars to free lunches and junkets, drug and medical device companies paid doctors and leading hospitals nearly $6.5 billion last year, according to government data posted Tuesday.

User comments : 0

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.