Death and Its Strange Bedfellows

There's a little flurry of interest on the web concerning the death by hospital decision of Tirhas Habtegiris, who I wrote about here, notably on skeptical community.com.

It seems to have been prompted by a commentary in Slate by Steven E. Landsburg. This column is obtuse in the extreme. There is no paragraph after the opening one in which Landsburg gets the point.

The opening graph however is interesting in how he decides to summarize the case:

Tirhas Habtegiris, a 27-year-old terminal cancer patient at Baylor Regional Medical Center in Plano, Texas, was removed from her ventilator last month because she couldn't pay her medical bills. The hospital gave Ms. Habtegiris' family 10 days' notice, and then, with the bills still unpaid, withdrew her life support on the 11th day. It took Ms. Habtegiris about 15 minutes to die.

The facts reproduce those in the two TV station reports, the only reporting I've seen. But he goes farther than those reports in stating categorically that Habtegiris was taken off life support because her bills weren't paid.

But then Landsburg goes off on a bizarre riff about the relative value of ventilator insurance and a quart of milk to a poor person. In countering a blogger's claim that pulling the plug on a conscious person wasn't "compassionate", he lectures thusly:

Now let me remind you what "compassion" means. According to Merriam-Webster Online (which, by virtue of being online, really ought to be easily accessible to bloggers), compassion is the "sympathetic consciousness of others' distress together with a desire to alleviate it." By that definition, there is nothing particularly compassionate about giving ventilator insurance to a person who really feels a more urgent need for milk or eggs. One might even say that choosing to ignore the major sources of others' distress is precisely the opposite of sympathetic consciousness.

It takes a very active if deformed imagination to interpret the act of compassion the blogger--or any other non-deluded person--meant as providing this woman with ventilator insurance (whatever that may be I personally have never seen it offered.)

Landsburg doesn't even bother to spell out his premise, as if we all share it with him: that if someone doesn't have ventilator insurance, or some other means to pay, then naturally they deserve to die.

Let's stipulate that there are some moral ambiguities in this situation, particularly in the fact that this woman would not live without the intervention of a ventilator machine. But it can be argued---and it seems to me---that this is a distinction in degree and not in kind, from any sort of life-saving care. If someone is denied medication to avoid an oncoming heart attack--if you refuse to go get the pills--how different is that?

To most reasonable people, the compassion referred to here is in continuing to provide care to a conscious living person, to abide by her wishes to continue living, and work out who is going to pay for it later (as if there aren't a thousand ways to manage that.) At minimum, to keep her on the ventilator until her final wish is granted: to die in the arms of her mother, then in Africa and unable to get to the hospital in Texas within the 10 day to death sentence. That's the "compassion" argument.

But there is an even more fundamental issue, which is: justice. How is this different from murder? This is reportedly a conscious person. Can you define keeping a machine on for the time it takes for her to die as extraordinary means? Yes, the woman was defined as terminally ill. But death is certain for everyone, though the time it will occur is generally uncertain. Everyone who is murdered is therefore dead "before their time," if that time might be 60 years or 60 seconds.

There are laws and rules about allowing certain terminally ill patients to die by withdrawing life support, but as far as I know, these require the patient to be persistently unconscious, or "brain-dead." In other words, the person as a person is already dead. There is an argument for "mercy killing" if the patient wishes to die rather than suffer prolonged pain leading directly to death. But neither of these seems to have been the situation. She was conscious, and not asking to be relieved of her life. The fact is that this woman's death at that time required an act: turning off the machine. Under the circumstances as we know them so far, how is that different in kind from hitting her in the head with a pipe?

And if a conscious person is denied life because she can't pay her bills, how is this different from murder for money?

My first concern here is that there has been no serious reporting on this situation. Until we know the facts in more detail--what the true situation in the hospital was, what the law was and what it says that was applied to her case, along with some idea of the laws and rules and ethics that bear on this situation, we're all just speculating.

However, if Landsburg's commentary is all we get, we're all in big trouble. Behind all our concerns is the spectre of you or me in that hospital bed. Maybe Landsburg is well fixed enough to not worry. Few of us are.