Pennsylvania Hospital Limits Care for Vulnerable Patients

By Liz Townsend

The Hospital of the University of Pennsylvania has decided to drastically limit the care it will provide for disabled patients who are in a so-called "persistent vegetative state" (PVS) or who are "minimally conscious," the Philadelphia Inquirer reported. Unless families object or the patient has left instructions, these vulnerable patients will not be admitted to intensive care or given surgery if they develop complications.

"What is going on here is a statement that certain lives have less value than other lives, and that the values of the institution trump those of the patient," Wesley J. Smith, author of The Culture of Death: The Assault on Medical Ethics in America, told the Inquirer.

Burke Balch, director of NRLC's Department of Medical Ethics, agreed. "The pro-life movement has long warned that the so-called 'right to die' would become a 'duty to die,'" said Balch. "Slating the 'minimally conscious' for involuntary death spotlights the bias the advocates of the 'quality of life' ethic too often have against people with disabilities."

The hospital's ethics committee formulated the new guidelines, which are expected to go into effect in a year. According to Horace DeLisser, co-chair of the committee, a PVS patient who develops a fever would receive "blood tests, antibiotics, a chest X-ray, urine tests," the Inquirer reported. But "he would not be admitted to an ICU. He would not be put on a ventilator or breathing machine. ... He would not get surgery."

The Inquirer article made clear that only the most determined families will obtain treatment for their family members. The newspaper paraphrased the remarks of Horace DeLisser, a pulmonary and critical-care doctor:

"Communication with families about patient prognosis and treatment will remain an important part of care, he said, and an assertive family could probably successfully fight the new policy. Penn also has a conflict-resolution process and offers the option of transferring the patient to another hospital."

In the press, hospital spokespeople have framed the issue as one of preventing the use of "grotesque" and "futile" treatments for patients who will never recover. They spoke about treatments such as CPR and inserting intravenous tubes in very negative terms.

Other supporters of limited care suggested that families are given too many options for treatment. "That's not the best way to approach the family because it makes the family feel responsible for ending the life of their loved one," Arthur Caplan, director of the University of Pennsylvania's Center for Bioethics, told the Inquirer.

Instead, Caplan said, they should be encouraged to do as little as possible for such patients. According to Caplan, "It's better for doctors to tell the family, "In our best judgment, sadly, there's nothing more we can do. We're going to begin the process of stopping aggressive care."

Balch said the new guidelines illustrate the need for pro-lifers in every state to push for legislation that will safeguard the right to life of all vulnerable patients. "There is a clear need for protective legislation that, at a minimum, will ensure that those denied lifesaving treatment against their will have a right to transfer to a willing provider and be given treatment until the transfer takes place," said Balch.