When is enough enough? When confronted with irredeemable circumstances, with a painfully obvious outcome, does it do justice to anyone to forestall the inevitable? What is to be gained ultimately by continuing to intervene in a lost cause? Is it humane or wise to persist? These are the questions raised not simply by the war in Iraq but by the medical care of patients for whom it has been determined that further treatment is futile. Consider the tragic case of young Emilio Gonzales, as reported by the Washington Post:
AUSTIN, April 10 — A 17-month-old deaf, blind and terminally ill child on life support is the latest focus in an emotional fight against a Texas law that allows hospitals to withdraw care when a patient’s ongoing treatment is declared “medically futile.”
Since Dec. 28, baby Emilio Gonzales has spent his days in a pediatric intensive care unit, mostly asleep from the powerful drugs he is administered, and breathing with the help of a respirator. Children’s Hospital here declared his case hopeless last month and gave his mother 10 days, as legally required, to find another facility to take the baby. That deadline, extended once already, was due to expire Wednesday, at which time the hospital was to shut off Emilio’s respirator. Without the machine, Emilio would die within minutes or hours, hospital officials have said.
But the child’s mother, Catarina Gonzales, 23, and lawyers representing a coalition of state and national disability rights advocates and groups that favor prolonging life persuaded a Travis County judge Tuesday to force the hospital to maintain Emilio’s care while the search for a facility to accept him continues. [full text]
While one can certainly empathize with this mother’s plight and understand her wish to fight for the life of her child, her efforts are ultimately in vain. By all accounts, Emilio’s life can only be prolonged, not saved or enhanced. That is the devastating truth. This opinion piece by Mark Davis in the Dallas Morning News seems to sum the case up well:
I cannot imagine Catarina Gonzalez’s pain.
Her little boy, Emilio, lies connected to tubes at Children’s Hospital of Austin. His 17 months of life has been a tragic struggle against a massively disabling condition called Leigh’s disease, and he is losing.
He is unable to breathe or eat on his own. Brain damage makes purposeful movement impossible. Now there is a debate over when â€“ or whether â€“ to stop the machines that keep him technically alive.
If this brings back memories of Florida’s Terri Schiavo case, it’s important to note some differences.
First, to the child’s benefit, there is no close relative with questionable motives striving to get the tubes pulled. Second, to the benefit of all of us, there are no charlatans circling the building insisting that he could be made well with the right treatment.
The disagreement arises over who decides when treatment becomes futile. As in the Schiavo case, the term “treatment” hardly applies. What we have is artificial sustenance of life in the face of a condition that would have long ago brought natural death.
This issue is now gaining volume in both the courts and the Legislature.
The hospital is invoking the state law that allows it to end life-sustaining procedures with 10 days’ notice. This gives families a window to find another facility that might agree to accept their loved one for further care.
Signed into law by then-Gov. George W. Bush (and favored at the time by Texas Right to Life) the deadline is imposed only after doctors and an ethics panel determine that the technology keeping the patient alive is of no benefit and may even be detrimental.
This is the belief of the hospital in little Emilio’s case. Hospital attorney Michael Regier says doctors consider the procedures necessary to keep the child alive “very invasive,” including vigorous suctioning of secretions from his lungs. [full text]