Let The Case Speak For Itself

I saw a post on facebook this week, a sad story of a man at the end of life who was denied a feeding tube by the hospital ethics committee, despite his request for one.  It appeared that he was competent, and since he was uninsured, the denial raised issues of financially-driven unethical behavior.  Responders to the post immediately invoked “death panel” conversations, and an article on the story, written by a hospice physician, suggested that this case reflected a general ethical lapse in American medicine. It seems to me that both responses represent exaggerations unmerited by this single, sad, inappropriate, and very likely unethical case.  Until there are a series of such cases documented with enough detail to evaluate the truth, we should decry the single case without hyperbole.

I do decry the case, with the caveat that I don’t have all the facts.  The patient appears to have had terminal pancreatic cancer, which often leads to a painful death. It is possible that the physicians believed that the feeding tube would preserve life but lead to greater suffering, which is not desirable, but they should have clearly conveyed that to the patient and then allowed him to make the decision.  If his lack of insurance figured into their decision, shame on them, and there is no justification for such behavior.  I feel for him and for his family, and will continue to advocate for humanism in medicine, which complements the basic ethical mandates to produce ideal medical care.

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