Baby Isaiah: Ethical dilemmas of modern medicine (1)

Source: The Province

Isaiah James May was born last October in a small town (population 7,000) in Alberta, Canada. For Rebecka May, age 23, this was her first child. The pregnancy was normal, and both mother and child were healthy at the time of delivery.
Labor was difficult, however. It went on for 40 hours, including four hours of pushing. It’s not clear why a Caesarian section was not performed. When baby Isaiah finally appeared, his umbilical cord was wrapped around his neck. This had deprived him of oxygen, and he suffered severe and irreversible brain damage.
The child was flown to a children’s hospital in Edmonton, where he was placed on a ventilator. After evaluating Isaiah’s condition, doctors recommended removing him from life support. His parents took the matter to court, and Isaiah remains on a ventilator and feeding tube, pending a legal decision.

Medical futility

Doctors take a vow to do no harm and are legally liable if they do. The ultimate harm, of course, is death. The Hippocratic Oath specifically states: “To please no one will I prescribe a deadly drug, nor give advice which may cause death.”
When health care professionals conclude that no amount of medical care will prevent a patient from dying, the situation is called medical futility: There are no actions that would be of any benefit. The parties involved in an end-of-life decision, however, may disagree about what is of benefit. Does it benefit the patient to be alive, but unconscious and on a ventilator? Increasingly these days, when health care providers disagree with the patient’s family on life-sustaining medical treatment, the only solution is a legal one.
There is a popular image of the medical profession as advocating the use of all available technology to keep patients alive, regardless of the futility, the patient’s pain and distress, and the considerable expense. That image includes the doctor who says “It’s not my responsibility to decide to end a life.”
The battle between the patient’s surrogates and health care providers has changed, however. In 1990, 80 percent of legal battles concerned families arguing for the right of their loved one to die. By 2005 the situation had completely reversed. Eighty percent of cases involved family members fighting for continued or more aggressive life support. Family members are battling doctors who have concluded such support would be wrong.
According to a 2005 New York Times article:

“Medical advances give people greater expectations, and they’re not willing to accept that death is inevitable; somebody somewhere can save Mom,” said Dr. Forrow, of Beth Israel in Boston. “They have way more belief that the decision … is partly up to them: my business, my body, my mom’s body. Fifteen years ago, it was the doctor’s purview alone.”

Living in the science fiction present

Baby Isaiah is an example of a family engaged in a legal dispute with health care providers. There was a similar case last November in the United Kingdom where it was the hospital that took the parents to court. Baby RB appeared to have a fully functioning brain, but he was born with a medical condition that meant he could not move any muscles, including those needed to breathe. He was on life support for over a year. After the case was presented in court, including evidence that the baby would face a “miserable, sad and pitiful existence,” the parents agreed to withdraw life support.
As I said when writing about Baby RB, no one these days would advocate that life-and-death medical decisions be left exclusively to the medical profession, even though this would relieve families of their agonizing decisions. Today’s medical world is modern both in its extensive technology and our insistence on patients’ (and their surrogates’) rights.
These difficult decisions will become increasingly common for patients of all ages — Infants, those at the end of a normal lifespan, and all those in-between who face life-threatening conditions. Wherever life-saving technology is available, there is a natural inclination to make use of it. This science fiction future, in which more and more individuals are tethered to a machine, is now our present way of life.
See part two of this post for a link to updates on baby Isaiah.
Related posts:
Baby Isaiah May, October 24, 2009 – March 11, 2010
Baby Isaiah: Ethical dilemmas of modern medicine (2)
Baby RB: Ethical dilemmas of modern medicine
The death of a child
Death be not visible
The enduring benefits of saving children
Climate change: Bad news for children’s health
When a doctor’s child is ill