Futile-Care Theory and Healthcare Rationing

Futile-Care Theory and Healthcare Rationing

"Futile care theory" is fast becoming acceptable with rising healthcare costs. It is foreseen that economics will be the driving force for acceptance of euthanasia by healthcare professionals.

  • The current debate is about transforming public policy to permit prescriptions for poison as "medical treatment"
  • Euthanasia advocates say "the hastened demise of people with only a short time to live, would free resources for others".
  • If assisted suicide and euthanasia were to be legalised in New Zealand, rationing would be inevitable.
  • In coming years there will be a huge increase in younger patients with diabetes needing expensive dialysis treatment.
  • Individual autonomy has increasingly given way to decision-making by health care professionals and bioethicists.
We reserve the right to refuse service: some shops display such signs and it looks as though some hospitals are heading the same way.

Futile-care protocols that prohibit doctors from treating patients who do not meet certain criteria, such as those who are in a coma or a 'persistent vegetative state' (PVS) doom these people to intentionally caused deaths by dehydration - even if they had previously signed an advance medical directive stating that they would want their lives maintained.

Euthanasia and Assisted Suicide as Acceptable Healthcare Economics
Derek Humphrys, the leading euthanasia advocate and founder of the Hemlock Society argues that it is inevitable and will be the main driving factor for social change.

Rita Marker of the International Task Force on Euthanasia has written on assisted suicide and cost containment. Her case is summarised here:
  • The law or medical ethics does not require that a person be kept alive by unwanted medical treatment
  • The current debate is about transforming public policy to permit prescriptions for poison as "medical treatment"
  • In Oregon, assisted suicide with lethal drugs is funded by some health insurance plans, or paid by the state Medicaid programme under "comfort care"
  • A prescription for a lethal overdose costs US$45, compared with the many thousands of dollars that would be spent on continuing health care
  • In the United States, patients used to be subjected to unneeded tests and treatments. This was money-driven because health providers were reimbursed by health insurance companies. The situation has now been reversed with the introduction of 'managed care'
  • Many managed care deliverers are profit driven, focused on shareholder value. Managers can delay or deny resources for services and "gag rules" prohibit doctors telling what interventions might be helpful. Some plans limit coverage for pain relief, or hospice care
  • Many potential patients are unaware that their health insurance coverage is limited in the 'fine-print'
  • Managed care guidelines strictly limit the time a doctor can spend with a patient (e.g. twenty minutes for first consultation, ten minutes for subsequent visits). This disallows the time needed to properly discuss assisted suicide with a patient
  • Some health care programmes reward doctors who conserve economic resources to patients, thus establishing a potential conflict of interest
  • A 1998 survey published in the Archives of Internal Medicine, revealed that the doctors most thrifty in saving medical costs, would be six times more likely than their counterparts to provide lethal prescriptions
  • If there is little or no palliative care available, the patient is forced to contemplate potential suffering, or assisted suicide
  • (Source: www.internationaltaskforce.org/ascc.htm)

Health Insurer Recruits Doctors for Assisted Suicide
An anti-assisted suicide group, Physicians for Compassionate Care, has reported that a leading US health insurer, Kaiser Permanente emailed 800 Kaiser doctors in Oregon seeking volunteers to administer assisted suicide.

Wesley Smith, an attorney for the International Task Force on Euthnanasia reports in 2002, that Derek Humphry, co-founder of the Hemlock Society has written in his latest book "Freedom to Die", that "the hastened demise of people with only a short time to live, would free resources for others". They estimate that hundreds of billions of dollars could then be spent on improving healthcare. They claim that "economic necessity" is the ultimate driving force behind the assisted-suicide movement.

Could this happen in New Zealand?
A senior doctor, with much experience in palliative care, was interviewed for this section. He said it has not been raised yet, but if assisted suicide and voluntary euthanasia were legalised, it would be inevitable. Hospitals are already underfunded and administrators are obliged to cut costs.

Most of the beds are occupied by the elderly, but in the coming years there will be huge increase in younger patients with diabetes needing expensive dialysis treatment. Treatment is expected to be rationed, with those not making the list potentially facing palliative care in the later stages or assisted suicide.

Healthcare Spending in New Zealand
Professor Frank A Frizelle, Department of Surgery, Christchurch Hospital wrote in an article published in the Journal of the New Zealand Medical Association, 21-February-2003, Vol 116 No 1169:
"The health needs of our society are the subject of continual discussion in the media. Those of us treating patients see the problems in front of us each day. The increasing restrictions on what the publicly funded health system will provide, the long waiting lists for surgery and first assessments, and the inability of public hospitals to see patients referred by general practitioners, are all problems claimed to be causing an "epidemic of unmet need".

The under-resourcing of health has been repeatedly addressed by reorganisation of the delivery of healthcare services. Many see this process as similar to the reorganisation of the deck chairs on the Titanic. The time has come to look at the funding issues behind health more closely, and consider whether it is necessary to spend more on health.

Doctors tend to see the inability of the system to deliver needed, quality, effective and timely healthcare as their problem. It is not; it is a political, economic and social problem, yet as our patients' advocates we feel it is our responsibility. The New Zealand healthcare system is now so lean that it has become mean.

Many patients with medical and surgical problems are no longer put on waiting lists because, as the government has said, it has become more important to be brutally honest and admit "we don't have the money, we can't help you". For some patients, this strategy will work; the general practitioner armed with this knowledge will help the patient get by, others will find a way to go privately, some will find their way back into the public sector, and yet others will just have to put up with their problems."

(Source: http://www.nzma.org.nz/journal/116-1169/324)
Another Professor from the Department of Surgery, Christchurch Hospital, Justin Roake, had this to say:
"New Zealand has adopted an explicit rationing system for access to elective surgical services. But it is sobering to reflect on the extent to which the New Zealand health system appears to have adopted rationing, in the light of the recent public debate on withdrawal of access to dialysis for a foreign national already established on renal dialysis therapy.

It can be argued that the publicly funded health system should not provide expensive healthcare for foreign nationals at the expense of New Zealand nationals, who are denied access to care from which they could benefit. However, the case in question has brought the issues into sharp focus.

In New Zealand, access to life-sustaining therapy is generally determined principally by clinical need rather than availability of resources. Admittedly, there are some exceptions in cases of exceptionally high-cost treatments but in general prioritisation or rationing of resources is much more a feature of elective health services directed at improved quality of life."

(Source: http://www.nzma.org.nz/journal/116-1175/454/)
Individual autonomy has increasingly given way to decision-making by health care professionals and bioethicists, whose 'futile-care' theory measures the value of human life according to the financial cost of keeping the individual alive.