Haleigh Poutre and ‘Ethical’ Dehydration March 15, 2006

Haleigh Poutre  11 years old, beaten nearly to death in September 2005 by her adoptive mother and stepfather  Within a week, doctors at Baystate Medical Center in Massachusetts diagnosed her as "virtually brain dead" from an irreversible coma

The courts decide  Once court-appointed guardian Harry Spence was told of the diagnosis (he never visited her), he sought court permission to remove her respirator and feeding tube  The court agreed and was affirmed by the Massachusetts supreme court despite pleas from the stepfather

“Brain dead”??  When Spence finally visited her, she was conscious and responsive  Spence called off the dehydration  Haleigh is now breathing and eating solid food on her own (though still on a feeding tube) while receiving therapy at Francisan Hospital for Children in Brighton

Wesley J. Smith  Attorney and consultant for the International Task Force on Euthanasia and Assisted Suicide, special consultant to the Center for Bioethics and Culture  Has filed amicus briefs opposing the legalization of assisted suicide and on other bioethical issues in federal and state courts

…and he’s coming here!  WJS will be speaking on March 29 in the Campus Center Little Theater at 7:30pm  “Bioethics: Creating a Disposable Caste of People?”

Euthanasia  “The intentional killing by act or omission of a dependent human being for his or her alleged benefit”  By action: performing an action, i.e., lethal injection, providing drugs in lethal amounts  By omission: not providing necessary and ordinary care

Dehydration?  Artificial nutrition and hydration (ANH) is defined in law and medical ethics as ordinary medical treatment that can be refused, like antibiotics or surgery  Thus, removing ANH is an "ethical" way to end the lives of disabled patients like HP and Terri Schiavo even though it’s euthanasia by omission

How did this happen?  In the 1980s, the bioethics movement launched a campaign to change the classification of ANH from humane care to medical treatment  In March 1986, the American Medical Association Council on Ethical and Judicial Affairs legitimized dehydration

AMA Statement  Said terminating life-support treatment was ethical even if: "...death is not imminent but a patient's coma is beyond doubt irreversible...life-prolonging medical treatment includes medication and artificially or technologically supplied respiration, nutrition and hydration."

Cruzan v. Director, Missouri Department of Health  In 1983, Nancy Cruzan woke up in a persistent vegetative state (PVS) after a car accident  4 years later, her family decided to remove her feeding tube  The Missouri supreme court ruled there wasn’t enough evidence that she didn’t want to be kept alive

To the Supreme Court  In 1990, the Supreme Court affirmed the Missouri law allowing removal of ANH given “clear and convincing evidence”  Yet it agreed that ANH is medical treatment  Soon all 50 states permitted withdrawal of ANH based on the Court’s ruling  Afterward, three close friends of Cruzan said that she didn’t want to stay alive; the Missouri court allowed removal and she died 11 days later

Once and again  In 1994, the AMA released another statement that broadened who may be dehydrated: “Even if the patient is not terminally ill or permanently unconscious, it is not unethical to discontinue all means of life-sustaining medical treatment…”  Terri Schiavo’s feeding tube was removed based on testimony that she was in a PVS

The Danger  Terri Schiavo’s death was not unique—look at Haleigh Poutre  WJS points out that Haleigh isn’t safe from dehydration even though she is conscious  Disabled people’s lives may become liabilities as long as ANH is considered medical treatment and third parties can decide to withdraw it

References  American Medical Association, “E-2.20 Withholding or Withdrawing Life-Sustaining Medical Treatment” assn.org/ama/pub/category/8457.htmlhttp:// assn.org/ama/pub/category/8457.html    Wesley J. Smith, “Like Terri Schiavo, Haleigh Poutre Not Safe When Others Decide Her Fate”

Euthanasia by Action  Indirect: providing treatment with known side effect of early death  Direct: actively inducing death (i.e., lethal injection)  Assisted suicide: providing means to patient in order to kill him/herself (i.e., providing drugs in excessive amounts—Oregon)