The Deadly Quality of Life Ethic | Wesley J. Smith – First Things

Something evil happened recently in Austin. Michael Hickson, a forty-six-year-old African-American man with quadriplegia and a serious brain injury, was refused treatment at St. Davids Hospital South Austin while ill with COVID-19. The hospital withheld his tube-supplied food and water despite the objections of his wife, Melissaand even though Michael might have survived the illness with the medical care generally provided COVID patients. Michael died on June 11 because his doctors did not believe he had a sufficient quality of life to justify curative treatment, and that because of his disabilities, saving his life was futile.

Heres the backstory: In 2017, Michael experienced brain injury after cardiac arrest. He was quadriplegic and had seizures. But he was conscious and, according to Melissa, able to do math calculations and answer trivia questions. Wasnt his life as precious as everybody elses? Not according to Michael's doctors. When Michael became sick with coronavirus, his doctor informed Melissa that treatment would not improve the quality of his life (meaning, he would remain quadriplegic and cognitively disabled if he survived), so the medical team and the state, through a court-appointed guardian, had decided all treatment except hospice comfort care should end.

Melissa was unable legally to save her husbands life by insisting that he receive proper care. Having been appointed Michaels temporary guardian, she was in a legal struggle with Michaels sister over his custody, a dispute that predated Michaels hospitalization. Family Eldercare, a nonprofit agency, had been appointed interim guardian until a final decision could be made about permanent guardianship. Doctors convinced Family Eldercare to approve Michaels transfer to hospice care even though he was breathing on his own. Michael died of pneumonia after six days on hospice, the withdrawal of artificial nutrition and hydration having no doubt weakened his bodys ability to fight disease. Even without pneumonia, Michael would have soon died of dehydration.

Please note that this wasnt a case of triage, a sad necessity required by a lack of resources in a time of pandemic emergency. Nor was it a situation of doctor said/wife said. Melissa recorded her conversation with the unnamed physician and posted it on YouTube so we can all hear for ourselves what families in these circumstances too often experience when dealing with the healthcare needs of disabled and elderly patients.

Heres the substance of the conversation from the YouTube transcript, with my commentary.

Melissa: What would make you say no to all of those?

Doctor: As of right now the quality of life, he doesnt have much of one.

Melissa: What do you mean? Because he was paralyzed with a brain injury, he doesnt have a quality of life?

Doctor: Correct

The doctor did not base his decision on the seriousness of Michaels illness, but on his continuing disability. This is a classic example of applying the invidious quality of life ethic, which deems people with disabilities, the elderly, the chronically ill, and the dying to have a lower moral worth than the healthy, able-bodied, and young; this ethic sometimes translates into denying the weak and vulnerable medical care that others would receive readily.

Back to the conversation:

Melissa: Why wouldnt it? Being able to live isnt improving the quality of life?

Doctor: Theres no improvement with being intubated, with a bunch of lines and tubes in your body and being on a ventilator for more than two weeks. Each of our people here have COVID and they are in respiratory failure. Theyve been here for more than two weeks.

A bit later, the doctor says that the decision is not Melissas to make.

Melissa: And I totally agree with you on the intubation part of it. I dont want him intubated. But I also dont think you should just sit him somewhere to be comfortable until he finally just drifts away. That to me is futile too. Thats saying youre not trying to save someones life. Youre just watching them go. The ship is sailing. I mean that just doesnt make any sense to me to not try. I dont get that part. I dont like that part.

Melissa is not asking for intubation. She is not asking for everything possible to be done. Rather, she wants proper care for Michael, which would presumably have included medicines and tube-supplied food and water.

The doctor becomes increasingly tired of the conversation:

Melissa: And the state. Forget about his wife and his family and his five kids.

Doctor: I have nothing to do with that.

The recording ends there.

What can we learn from this? First, people should sign advance directives naming legal surrogates who will make medical decisions for them in the event of incapacity. Michael had apparently not done that. Had Melissa been Michaels legal surrogate, it is very possible he would be alive today, because she would not have consented to his transfer from acute care to hospice.

Second, the quality of life ethic is deadly. When doctors fail to recognize life itself as a good, and only deem as good those lives they perceive to be of sufficient quality, the weak and vulnerable are put at material risk.

Finally, our societal attitudes need adjusting. Rather than upholding a quality of life ethic, we should insist that society generallyand medicine specificallyadhere to the sanctity/equality of life ethic, according to which everyone is considered equally valuable and worthy of living and care. This ethic would not force people to accept medical treatment they do not want. But it would keep the most weak and vulnerable among us, people like Michael Hickson, from being pushed out of the lifeboat by doctors who cant imagine why anyone with quadriplegia and cognitive incapacities should go on living.

Wesley J. Smith is a senior fellow at the Discovery Institute. His latest book isCulture of Death: The Age of Do Harm Medicine.

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The Deadly Quality of Life Ethic | Wesley J. Smith - First Things