Imagine visiting your 75-year-old mother in the hospital after she has had a disabling stroke. She is unable to speak or swallow. Her immediate needs include artificially provided food and fluids (tube-feeding) and antibiotics to fight an infection. If she survives, nursing home care as well as physical and speech therapy will be required to help her recover. Your mother chose you to be her health care decision-maker (agent) and told you that, no matter what, she wants to live. Nevertheless, her attending physician refuses to provide further “life-sustaining treatment”—including tube-feeding. When you object, the doctor explains that this is what he thinks is best for your mother. You are stunned.

Sound far-fetched? It’s not. Similar scenes are playing out all over the country in hospitals which have quietly adopted “futile care policies.” These policies are based on the theory that a physician is entitled to refuse life-sustaining treatment when he/she believes the quality of a patient’s life is too low or the cost is too high to justify further treatment. Such policies permit so-called “futile care” to be stopped, not because the care or treatment won’t sustain the patient’s life, but precisely because it will. If the patient, family or agent objects, the case is referred to the hospital ethics committee for the final decision.

A hard question needs to be asked. Is it advisable, or even legal, for doctors and hospital ethics committees to have this kind of power?

In 1998, I was interviewed for an article entitled “Medical Futility: Who has the power to decide?” which appeared in Nurse Week and Health Week. I said then that I believe medical futility policies are designed for one reason: cost-containment. And, I say it again. The high-sounding motive of “doing what is best for the patient” is simply camouflage.

Most people assume that they will have the right to make their own medical decisions. Insistence, against a patient’s wishes, that every means be used to postpone death would be senseless and inhumane. (While we have a moral obligation to use ordinary means to preserve our lives, treatments that are extremely burdensome, overly zealous or otherwise extraordinary are optional.) However, it is just as cruel to refuse available and potentially effective treatment to a patient who wants it. If a person wants to fight for every last moment of life, this is his or her right. There is absolutely no concern for the rights of patients in “futile care” policies.

Not only do these policies permit the wishes of a patient’s family and even a patient’s advance directive (Living Will or Power of Attorney for Health Care) to be ignored, they also allow doctors to override the medical decisions of a patient who is conscious and asserting the desire to live! The essence of any “futile care” policy is involuntary euthanasia by omission. [Catechism of the Catholic Church (CCC), 2277-2278]

“Futile care” policies make people with disabilities extremely nervous. Diane Coleman, president of the disability rights group Not Dead Yet, says, “It’s not news to us that health professionals judge our quality of life to be far less than how we judge it ourselves. The view that our lives are futile is frightening, no matter who holds it.” (“A Duty to Die” by Karla Dial, Citizen magazine, 2/04.)

“Quality of life” judgments are extremely unsettling. Based on the notion that certain lives are not worth living, they are totally incompatible with the fundamental Christian principle that “human life is sacred.” [CCC, 2258] Part of the spiritual war being waged between the Culture of Life and the Culture of Death is the ethical battle between the Sanctity of Life Ethic and the Quality of Life Ethic. We all have a stake in the outcome. If the Quality of Life Ethic prevails, hospitals may as well post signs warning patients, “We reserve the right to refuse treatment to anyone.”