Who gets to decide on end-of-life health care?

In 2005 the nation watched while the Florida health care facility housing a young woman named Terri Schiavo endured a barrage of contradictory, whiplash-inducing orders to insert and remove the feeding tube that had kept the comatose woman alive for a decade.  Her parents and brother insisted Shiavo was responsive and would, in time, regain function. Shiavo's husband insisted she would never have wanted to languish, vegetative, in a health care facility following her cardiac arrest. Lawsuits were filed, protestors gathered at the state Capitol in Tallahassee and even the governor got involved. Eventually, Schiavo's husband prevailed, all supportive health care procedures were stopped and Schiavo died. The matter seemed resolved.

Yet, despite the specter of the so-called "death panels" raised last year during the health reform debate, the issue of end-of-life health care decisions has been laid anywhere but to rest. Another potentially precedent-setting case in New Jersey illustrates just how emotional - and volatile - the issue is, and how it can continue to split not only families of patients but the health care providers who oversee them. A New Jersey appeals court heard arguments in April on a case that is expected to clarify health care providers' part in determining treatment in what are consider medically futile cases.

According to the American Medical Association's amednews, judges will decide whether family members could compel Trinitas Regional Medical Center in Elizabeth, New Jersey to continue life-sustaining health care for their comatose father when hospital doctors believed further treatment was medically inappropriate. A trial judge in March 2009 blocked Trinitas from discontinuing life support for 73-year-old Ruben Betancourt, who fell into a coma after complications from cancer surgery. After the family sought treatment at other facilities, Betancourt was readmitted to Trinitas for renal failure and started on dialysis, ventilator support and tube feeding, according to court records and amednews. Betencourt died in 2009.

Just as in the Schiavo case, family members disagreed with the health care providers' declaration that their father was in a persistent vegetative state and that further treatment was futile and inhumane. Representatives for the health care facility say it is the role of families to choose among medically appropriate health care options, not to determine what is medically appropriate in the first place. That determination, they say, belongs in the hands of the medical experts. Lawyers for the family say they weren't trying to demand extraordinary measures; they just didn't believe the hospital could end life-support over their objections.

So who does get to make end-of-life health care decisions, and how do we balance patients' rights with medical liability? Right now the health care industry is trending toward more transparency and empowerment of patients and families - they are becoming less like patients and more like health care consumers. Yet it is the doctors and hospitals which, overwhelmingly, bear the legal liability for health care decisions - just ask to see their medical malpractice insurance premiums. Better solutions than running to court need to be found, though it will be very interesting to see what the New Jersey appellate judges decide in a few weeks' or months' time.

Photo Credit: brykmantra