Tuesday, March 8, 2011

No Money = Catholic Hospital Starving A Woman To Death

This story is heartbreaking and enraging:
On Feb. 19, Ms. Nyirahabiyambere’s feeding tube was removed on the order of her court-appointed guardian. Her six adult children — including two United States citizens — vehemently opposed that decision. But they were helpless to block it when Georgetown University Medical Center, frustrated in its efforts to discharge Ms. Nyirahabiyambere after she had spent eight costly months there without insurance, sought a guardian to make decisions that the family would not make.

“Now we are powerless spectators, just watching our mother die,” said Mr. Ndayishimiye, 33, who teaches health information management at the State University of New York’s Institute of Technology in Utica. “In our culture, we would never sentence a person to die from hunger.”

Decision-making on behalf of patients in persistent vegetative states is always a delicate matter, especially if, like Ms. Nyirahabiyambere, they have not left a directive. Her case, which has received no public attention, underscores the thorny issues that arise when a severely brain-damaged person’s life is sustained by medical technology.

With thousands in persistent vegetative states, the issues regularly surface in hospitals and courtrooms — what constitutes “futile care,” what power should doctors or lawyers have to stop treatment and what role should financial considerations play.

In Ms. Nyirahabiyambere’s case, her immigration status adds another layer of complexity.

With less than five years in this country, she is ineligible for the Medicaid coverage that would have paid for her to live indefinitely with a feeding tube in a nursing home. As her children see it, her life is being cut short because she is an indigent immigrant. “It’s all about money,” Mr. Ndayishimiye said.

But her guardian, Andrea J. Sloan, said that prolonging the life of “someone profoundly vegetative” would be questionable even if insurance were available because palliative care is more appropriate. “The essential question of the feeding tube has nothing to do with nationality or payor source,” she said.

Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, said the case underscores that “end-of-life decisions have to be treated with great sensitivity — and, ideally, with families fully involved and respected.”

He added: “Any hint that withdrawing treatment might be linked to financial considerations — that’s a huge ethical no-no. That’s death panel stuff.”
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