Unethical “quality of Life” assessments threaten lives of elderly patients

Assisted suicide activists continue an insidious attempt to normalize euthanasia.  As this deadly message spreads, we hear with increasing frequency dangerous and unethical arguments for ending life-sustaining care against a patient’s wishes, especially for the elderly.  Under Texas law, a hospital committee has the power to decide to end life-sustaining care, even if ending that care—and thus ending the patient’s life—is against the wishes of the patient and the patient’s family.  Although the anti-Life Texas 10-Day-Law is particularly egregious, a report from National Right to Life finds that most states do not provide patients with basic protection of the Right to Life in the face of subjective “quality of life” assessments by doctors entrusted with the patient’s care.

Many people, especially seniors, prepare an advanced directive to inform doctors of their wishes in case they become incapacitated or unable to communicate their desired course of care.  As National Right to Life’s Robert Powell Center for Medical Ethics found, despite properly prepared legal documents, patients are still at risk.  State laws do not adequately protect and honor the patient’s wishes in the advanced directive, allowing doctors and hospital administrators to make Life and death decisions.  Disturbingly, the report showed that the reason for denying care was most often not that the continuation of care was contraindicated (by directly causing the patient harm) but instead a subjective assessment of the patient’s “quality of life.”

Anti-Life activists have long argued that prolonging Life can be contrary to quality of life, and therefore doctors should be justified in ending lives when they deem care “futile.”  By this, anti-Life activists imply that patients lose the Right to Life if their condition becomes debilitated or burdensome.  The sanctity of human Life extends from conception to natural death, and if we deny those with disabilities or in advanced age the Right to Life, we are all at risk.  Often implicit in the anti-Life “quality of life” argument is the assumption that the medical establishment should be given the power to determine when a patient’s “quality of life” is too poor to justify care.  Suggestions of these lines of arguments are found in an article entitled “I Know You Love Me—Now Let Me Die” published online earlier this year.

In the article, Dr. Louis Profeta argues that medical interventions offered to the elderly carry the risk of prolonging Life to the detriment of the patient’s wellbeing.  Although he does not advocate assisted suicide, Dr. Profeta’s arguments carry suggestions of a focus on “quality of life” that can lead to the desecrating the Right to Life.  He suggests that by caring for a hypothetical elderly woman, doctors “imprison her in a shell that does not come close to radiating the life of what she once had.”  He also speaks of the woman’s young adult life as “enriched and happy,” implicitly contrasting that time with old age, which in his assessment is a prolonged Life without quality.

The author is concerned with cases of well-intentioned loved ones electing for invasive treatment on behalf of elderly family members.  As someone who has treated thousands of elderly patients, Dr. Profeta has many graphic examples of what he views as overly aggressive treatment in aging patients.  He claims that his colleagues share his concerns and regularly ask each other, “How do we stop this madness?  How do we get people to let their loved ones die?”  The answer is certainly not, as some might think his argument implies, to end the lives of the elderly.  The answer is also not to give doctors the right to decide a patient’s course of treatment.  Dr. Profeta claims the ability to discern a special trust from an elderly patient who is no longer capable of speech.  Based on that supposed, trust he knows that the patient would want to end care because Life is no longer worth living.  Such a claim is at the heart of the Texas 10-Day-Law and the anti-Life movement to normalize assisted suicide.

Patients and their families can choose not to pursue invasive or experimental treatment.  They can choose to spend the final days of their lives in their homes instead of in a hospital.  However, that choice must be based on the informed consent of the patient and his or her legal medical surrogate.  Those same patients have the Right to Life no matter their age, condition, or disability.  As such, medical treatment, especially life-sustaining care, cannot be denied.  A doctor’s biased assessment of the patient’s “quality of life” cannot determine the difference between Life and death in an ethical society.