The Magazine

"Futile Care" and Its Friends

They want to decide when your life is worthless

Jul 23, 2001, Vol. 6, No. 42 • By WESLEY J. SMITH
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WHEN JOHN CAMPBELL’S TEENAGE SON CHRISTOPHER became comatose after a car accident in 1994, the last problem Campbell expected was obtaining proper medical treatment for his son. Campbell, a corporate executive, had excellent health insurance and was convinced Christopher would receive the best of care. But then something awful happened. One month after the accident, Christopher developed a burning fever. When his temperature reached 105—and rising—Campbell asked the attending nurses why his son was not being treated for the condition that now threatened his life. He soon found out: Christopher’s doctor was out of town and the on-call physician had refused to order care. The nurses told Campbell they were helpless to act on their own.

Campbell demanded to speak with the doctor. It took hours before the nurses were able to reach him on the phone. By then Christopher’s fever had worsened to 107 degrees. "He was literally burning up," Campbell recalls. "I knew that if something was not done, he would die."

Campbell demanded treatment to reduce his son’s fever. At first, the doctor refused. "He actually laughed," Campbell recalls. But the distraught father wouldn’t give up: "I raised holy hell. I used every ounce of persuasion I had in me." Finally, reluctantly, the doctor ordered the nurses to provide fever-reducing medicine, and the fever subsided.

Christopher was completely unresponsive for more than four months after the fever incident. Then, against medical expectations, he awakened. Today, after years of arduous rehabilitation, he lives with his parents, a disabled young man who counsels troubled teenagers and who, with his father’s help, created a foundation that feeds 30 hungry African children breakfast 365 days a year. But had Campbell not successfully pressured the doctor into saving Christopher’s life, none of that would have happened. Christopher Campbell would be a cherished memory instead of a living son.

The physician’s refusal to provide Christopher desired life-sustaining treatment was an early application of a relatively new bioethical theory that has since swept the Western medical world. "Futile care theory" holds that when a physician believes the quality of a patient’s life is too low to justify life-sustaining treatment, the doctor is entitled to refuse care as "inappropriate"—even if the treatment is wanted. It is the equivalent of a hospital putting a sign over its entrance stating, "We reserve the right to refuse service."

Of course, doctors should not be required to provide physiologically futile treatment. For example, if an ulcer patient demands chemotherapy, doctors should refuse, since the desired "treatment" would not improve the ulcer at all. But "physiological futility" of this sort is not the essence of contemporary futile care theory. Rather, in medical futility bioethicists and doctors unilaterally determine when the quality of a human life, or the cost of sustaining it, makes it not worth living.

Proponents of futile care theory often cite tube feeding for patients in a persistent vegetative state as an example of "futile" or "inappropriate" treatment. Let’s analyze this. What is the medical purpose of "artificial nutrition"? It keeps the body functioning. Why do many futilitarians (as they are sometimes called) wish to authorize doctors to refuse such treatment? Not because it doesn’t work—as in the example of the demand for chemotherapy to treat an ulcer—but because it does. Thus in futile care theory the treatment itself isn’t denigrated as futile—the patient is.

One way patients or families currently thwart futile care impositions is by threatening to sue. To counter this threat, futilitarians are moving on two fronts to all but guarantee that courts will ultimately acquiesce to futile care theory. First, in hospitals nationwide they are quietly promulgating formal, written futile care protocols that establish procedures under which wanted treatment can be refused. Second, they are beginning to place language in federal and state legislation that would stamp the government’s imprimatur upon the core principles of futile care theory.