Saturday, July 3, 2010

Adding Up Futile Care

Via Thaddeus Pope:

L. Syd M Johnson, a research fellow in neuroethics at Novel Tech Ethics, Dalhousie University, has an article in today's Bioethics Forum (The Hastings Center), titled "Withholding Care from Vegetative Patients: Financial Savings and Social Costs."

Johnson responds to Jacob Appel's recent argument in theHuffington Post that medical resources should not be devoted to PVS patients. He first notes the misdiagnosis rate. He then notes the fMRI studies that suggest PVS patients have some awareness. Finally, Johnson explains why there would be no much cost savings from denying treatment to PVS patients.

I think that these are just the right arguments to make. But I am not convinced. First, we accept a rate of error in all sorts of analogous treatment decisions. Even with respect to death itself, we'll declare death after 75 or 90 seconds even though theremight be spontaneous resuscitation of cardiopulmonary function. Second, the fMRI studies are far too preliminary to ground big shifts in policy and procedure. Third, the initial cost savings of ceasing treatment of PVS patients will be nearly $8 billion (30,000 x $250,000). The subsequent annual savings will be lower. But adopting Appel's rule will be an important precedent that will help usefully shape other procedures and guidelines.