MEANING OF TREATMENT, COST OF CARE

What is “treatment” in the legal sense?

Toronto attorney Charles B. Wagner’s blog has an insightful consideration of the term and the distinction between the wishes of the patient and those of a substitute decision-maker, as relates to the Rasouli case in Ontario, Canada. Find it at http://bit.ly/vKeyqT

In short, this is the case of a family successfully suing to stop doctors from removing a man, diagnosed in permanent vegetative state, from a ventilator. As Wagner notes, doctors argued they were inhumanely extending death, not life, and felt that “continuing unnecessary treatment diminishes the quality of life of the patient and exposes him to gratuitous discomfort and indignity.”

Though the Rasouli family are Shia Muslim, the case has particular ramifications for Jews, Wagner writes. “Do we want a stranger whose views on end of life issues may not be in accordance with halacha to be the decision maker?”

Another compelling aspect of this case is an especially hot button in end-of-life treatment: cost.

“Our health care system is in crisis,” Wagner writes. “Many say that it is underfunded and mismanaged. ... The hospital, separate and apart from the doctors, brought up the issue of limited resources. At the hearing, their lawyer argued that hospitals could be overwhelmed with individuals with no hope of recovery remaining on life support for extended periods of time and thereby deny those who can be helped access to scarce resources. This issue was not argued at the Court of Appeal, but it is an issue of importance. Is the lack of funding a driving issue in this debate?”

(Thanks to medicalfutility.blogspot.com for the tip to Wagner’s blog.)