Futile care theory is something going on in many parts of the world, including the United States. The essence of futile care theory is that doctors have the right to cut off, or withhold wanted medical care to the cognitively impaired, based on a personal value judgment that their life is not worth preserving, because their life is not worth living.

While I find this practice unethical, those in support of futile care theory make a persuasive case that can beguile the public. Consider bioethicist Arthur Schafer. In the Winnepeg Free Press he wrote:

Inevitably, doctors are the gatekeepers for patient access to medical resources. You can’t obtain restricted medicines unless a doctor is willing to write a prescription; you can’t gain admission to hospital unless a doctor decides that you will benefit thereby. There is a scarcity of intensive care beds; so, to admit or keep patients in the ICU who cannot benefit is to rob others who could benefit. Put simply, one person’s provision is another person’s deprivation. It’s unethical to waste scarce life-saving resources.


If a patient will never again know who or where he is, as appears to be the case for Golobchuk [a Canadian man who is the subject of a legal battle because doctors want to deprive him of medical care], then to artificially prolong his breathing seems at best a waste of precious ICU resources and at worst a cruel ordeal for the patient. Doctors and nurses are not simply technicians providing marketplace services to customers. They are health-care professionals who are bound by the ethical obligation “first of all, do no harm.” When a patient has irreversibly lost self-awareness, then using medical high technology in a vain attempt to resist death is often experienced by doctors and nurses as both unprofessional and deeply demoralizing. Physician integrity includes the right, even the duty, to say “no” when treatments offer no genuine benefit to the patient.


Schafer’s argument is very utilitarian and pragmatic, and this appeals to Westerners (who are very utilitarian and pragmatic). So what is wrong with it? Wesley Smith, a lawyer and long-time advocate against euthanasia and futile care points out the flaws:


Forget for the moment the many times doctors have been wrong about people never regaining consciousness. Schafer is the one de-professionalizing medicine. A plumber can refuse to unclog a pipe, but a doctor has no right to abandon his or her patient. Moreover, Schafer wants doctors to impose their value judgments–as instructed in continuing education clases by bioethicists like Schafer–that the burden of treatment isn’t worth the benefit of continuing to live. But that isn’t a medical judgment, it is a value judgment that we have always been told resides with the patient and family. Moreover, the treatment isn’t being stopped because it doesn’t or might not work but because it does or will–and hence it is not really a “vain attempt to resist death,” but a potentially successful one. And thus it is really the patient who has been declared futile.


Schafer says that staying alive when that is what the patient wants offers no genuine benefit to the patient. He only has the right to make that claim for himself, not for Mr. Golobchuck, you, me, or anyone else. You are watching the redefining of the ultimate purpose of medicine before your very eyes. It isn’t keeping patients alive who want to live, it is treating those who can be cured and reserving the right to refuse service to those who probably won’t improve.


This is what socialized medicine–and its’ private equivalent the HMO–creates. Medical futility is health care rationing that pits one cadre of patients against others, leading to division and discord. It is the end of trust in medicine because if you are too sick or profoundly disabled, medicine wants little to do with you.


Finally, if Futile Care Theory prevails, what in the world makes anyone think that the forced removal of people from wanted treatment will stop at the ICU? People who only need feeding tubes will soon be dehydrated (if they are not lethally injected first), and care will be rationed based on other criteria. For example, as reported in my books, I once asked a futilitiarian what would come after futile care, since cutting off the dying would not save a lot of money. He immediately said restricting “marginally beneficial care.” I asked for an example. He responded, “An 80-year-old woman who wants a mammagram.”


Be afraid. Be very afraid.


Well said.