Withholding Care from Vegetative Patients: Financial Savings and Social Costs

L. Syd M Johnson
07/02/2010

In a recent column in the Huffington Post, Jacob M. Appel argues for “rational rationing” of health care resources by withholding and withdrawing life-sustaining medical treatment from patients in a permanent vegetative state. He considers the case of Ruben Betancourt, which will soon be decided by the New Jersey Superior Court in Betancourt v. Trinitas Regional Medical Hospital.

Mr. Betancourt was a patient at Trinitas Regional Medical Hospital in Elizabeth, N.J., where he had successful surgery for a malignant thymoma in January 2008. But Mr. Betancourt suffered oxygen deprivation, resulting in severe brain damage, after accidental extubation of his breathing tube following the surgery. He lapsed into unconsciousness and was subsequently moved to various health care facilities, including a nursing home, where he was sustained on a feeding tube and dialysis.

When Mr. Betancourt was readmitted to Trinitas in July 2008 with renal failure, doctors balked at providing dialysis, artificial nutrition and hydration, and artificial ventilation, claiming that the patient was in an irreversible vegetative state, was actively dying, and that further treatment was medically and ethically inappropriate and inhumane. The hospital sought to remove him from life support. Mr. Betancourt’s daughter objected, saying that she thought her father was aware and reacted to his family, and that he was responding to treatment. Although he left no advance directive, his family believed that he would have wanted treatment continued. A legal battle ensued between the family and the hospital.

Mr. Betancourt died in May 2009, but his legal case remains on appeal. The court’s decision could have important implications for legal debates about medical futility, patient autonomy, and questions about when and under what circumstances doctors and hospitals can refuse to provide life-sustaining care to patients. the rest

There are substantial social costs to declaring an entire class of patients “worthless.” Allowing health care providers, including institutions like acute care hospitals, to unilaterally decide, against the wishes of patients or their legal guardians, to withhold life-sustaining medical treatment invites abuse and diminishes transparency and due process.

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