Imagine visiting your 85-year-old mother in the hospital after she has a debilitating stroke. You find out that, in order to survive, she requires a feeding tube and antibiotics to fight an infection. She once told you that no matter what happened, she wants to live. But the doctor refuses further life-sustaining treatment. When you ask why, you are told, in effect, “The time has come for your mother to die. All we will provide is comfort care.”
Sound far-fetched? It’s not. It’s already happening.
Just as doctors once hooked people up to machines against their will, now
many bioethicists advocate that doctors be permitted to refuse
life-sustaining treatment that a patient wants but that they deem “futile”
Alarmingly, hospitals in California and throughout the country have begun
to implement these “futile-care” policies that state, in effect: “We
reserve the right to refuse service.”
Medical and bioethics journals for several years kept up a drumbeat
advocating the implementation of medical futility policies that hospitals
— for obvious reasons — don’t publicize. The mainstream news media have
generally ignored the threat.
As a consequence, members of the public and their elected representatives
remain in the dark as “futilitarians” become empowered to hand down
unilateral death sentences.
Indeed, futile-care policies are implemented so quietly that no one knows
their extent. No one has made a systematic study of how many patients’
lives have been lost or whether futile-care decisions were reached
according to hospital policies or the law.
The idea behind futile care goes like this: The patient wants life-
sustaining treatment; the physician does not believe the quality of the
patient’s life justifies the costs to the health institution or the
physical and emotional burdens of care; therefore, the doctor is entitled
to refuse further treatment (other than comfort care) as “futile” or
Treatments withheld under this policy might include antibiotics to treat
infection, medicines for fever reduction, tube feeding and hydration,
kidney dialysis or ventilator support.
Of course, physicians have never been — nor should they be — required to
provide medical interventions that provide no medical benefit.
For example, if a patient demands chemotherapy to treat an ulcer, the
physician should refuse. Such a “treatment” would have no medical benefit.
But this kind of “physiological futility,” as it is sometimes called, is
not what modern futile-care theory is all about.
Stem Cell Research and a Ban on Human Cloning
Stem Cell Research and a Ban on Human Cloning
Some biotechnology companies claim that a ban on producing human embryos through cloning would stall important research in generating “stem cells” to cure a variety of diseases [Cong. Record, 2/5/98, S425]. To put this claim in perspective:
1. Cloning is desired as a source of “customized stem cell lines” which would be an exact genetic match to each individual patient with a given disease. But this would require each individual patient to undergo somatic cell nuclear transfer to produce one or many living human embryos who genetically are the patient’s identical twin sisters or brothers. These embryos would then be destroyed to provide embryonic stem cells.
Two methods of obtaining the cells have been described. In one, the embryo is allowed to develop normally for a week or two to the blastocyst stage, at or after the usual time of implantation in the mother’s womb; then this embryo, consisting of hundreds of cells, is dissected for its stem cells. The other method is to introduce molecular signals into the embryo’s environment to “trick” its cells into departing from normal development and instead producing “a mass of undifferentiated tissue,” which can then be reprogrammed into various kinds of cells [Lee Silver, Remaking Eden: Cloning and Beyond in a Brave New World (Avon Books 1997), p. 128]. In either case, the living embryo is destroyed.
2. This avenue for providing medical benefits has been described even by supporters as “largely conjectural” (J. Kassirer and N. Rosenthal, in New England Journal of Medicine, March 26, 1998, p. 905). President Clinton’s National Bioethics Advisory Commission called it “a rather expensive and far-fetched scenario.” The Commission observed: “Because of ethical and moral concerns raised by the use of embryos for research purposes it would be far more desirable to explore the direct use of human cells of adult origin to produce specialized cells or tissues for transplantation into patients.”
The Commission outlined three alternative avenues for promising research using stem cells that do not involve human cloning, two of which do not use human embryos at all (Cloning Human Beings: Report and Recommendations of the National Bioethics Advisory Commission, June 1997, pp. 30-31).
The Commission’s Alternatives
The alternatives outlined by President Clinton’s Commission are as follows:
1. Generating “a few, widely used and well characterized human embryonic stem cell lines, genetically altered to prevent graft rejection in all possible recipients.