Pulling the Plug on Unwilling Patients

Should the high cost of living affect your chances of dying?

I somehow missed the culture war moment last month when it was reported that Baylor Regional Medical Center in Plano, Texas, disconnected a dying, uninsured cancer patient, Tirhas Habtegiris, from the ventilator that was keeping her alive. The 27-year-old abdominal cancer patient was conscious and did not wish to be disconnected because she hoped that her mother would arrive from Africa for one last visit before she died. The hospital warned the patient and her family that it would keep her on the ventilator for just 10 more days. Ms. Habtegiris died 16 minutes after the ventilator was shut off on December 14, 2005.

The hospital acted pursuant to a law passed in 1999 that allowed it to discontinue "inappropriate" medical care despite the wishes of a patient or the patient's family.

There was not much mainstream media coverage, but the left-hand side of the blogosphere erupted over the incident. Many focused on savaging economist Steven Landsburg's article, "Do the Poor Deserve Life Support?" at Slate where he suggested that disconnecting Ms. Habtegiris was all right.

These left-leaning bloggers and commentators were in favor of leaving the ventilator on. Curiously, as far as I can tell, very few right-wingers and pro-lifers, who were in high dudgeon over the Terry Schiavo case, have commented on the Habtegiris case.

This horrible situation raises a number of hard questions. First, would the hospital have cut off the ventilator had Ms. Habtegiris had insurance to pay for it? The hospital insists that was not the issue, but one can't help wondering. A second harder question is what obligation do physicians, hospitals and the rest of us have to pay for the health care of others?

My impression of the controversy is that most left-wingers believe that every conscious patient should have as much medical care as they want regardless of the cost to the rest of us. On the other ideological hand, right-wingers seem confused. As the Terri Schiavo case showed many apparently want to offer unlimited medical care to brain-dead patients whose wishes are unknown or contested by family members. Meanwhile their silence in the Habtegiris case might be construed to mean that it's all right to make hard-headed decisions like denying medical care to conscious patients who are indigent.

As someone who is very conscious of his mortality, I joke with my friends that the whole U.S. gross domestic product should be spent keeping me alive when I fall ill. Surely both progressives and conservatives can see that that would be wrong (though I certainly won't object if y'all want to go ahead and do that for me—and, by the way, thanks in advance). There has to be a limit to what is spent on every individual's health care short of the whole U.S. GDP.

Progressives object that as a poor (legal) immigrant, Ms. Habtegiris, couldn't afford health insurance. Perhaps that is right. But what if she'd had insurance—perhaps even generous, gold-plated coverage—and had still exceeded her benefit limit? Who decides what your ultimate—and I do mean ultimate—limit is? One left-leaning commentatorrailed against placing "in the hands of 'authorities' the power to kill people who are unable to pay their medical bills." But if not "authorities," then who?

Critics of Baylor's decision should also bear in mind that it's not as though Habtegiris did not receive medical care. She was admitted to one of the finest hospitals in America, which did treat her illness. We know that she was in intensive care at the hospital for at least 10 days and probably more. A recent study of intensive care using a ventilator calculated the cost at $2,255 to $3,040 per day, so her stay at Baylor cost the hospital at least $22,550. That's $22,550 that someone else's insurance or taxes will have to cover through increased costs.

Government-run universal health care favored by many left-leaning critics is no solution either. The "authorities" at the National Health Service in Britain also decide who to ventilate and who resuscitate. Consider the case of Charlotte Wyatt, who was born three months premature in Portsmouth, England. Weighing just one pound at birth, her physicians insisted that resuscitating Charlotte if she stopped breathing would be "pointless and possibly inhumane" because it would only prolong her suffering. NHS officials won a ruling in Britain's High Court that they did not have to put the gravely ill baby on a ventilator again if she stopped breathing. It turns out that Charlottes' NHS doctors were wrong about her ability to survive. Although Charlotte still suffers from a number of severe disabilities, she's at home now. Nevertheless, even the vast resources available to government health care services are limited and tough decisions have to be made on how to allocate them.

The end of Ms. Habtegiris' life was tragic. The good news is that most of us will die without having to confront such hard choices. Perhaps it was wrong for Baylor to pull the plug in this instance, but it is clear that in the real world of limited medical resources that the "authorities," whether private or governmental, will unavoidably be making similar life and death decisions in the future.