The counterpoint by state Sens. Jim Abeler and John Hoffman ("Bring on the 'right to live' debate," Jan. 25) to the commentary by Drs. John Hick, Michele LeClaire and Heidi Erickson ("When death is coming, difficult choices are required," Jan. 20) completely missed the point of the original article and is embarrassing in its lack of understanding of the issues as well as in their proposed alternative. As a call for public debate, it sets the bar extremely low regarding the quality of any such debate. As the doctors made clear in their carefully reasoned and well-written article, the difficult choices that arise in medical care due to limited resources are not about evaluating the worthiness of any individual to live but about the complex process of medical decisionmaking as it relates to both individual patients and the use of societal resources.
As they discuss, these decisions are by nature societal. They do not call for the right of individual physicians to arrogantly decide who is worthy to live but for work on a national consensus. Abeler and Hoffman use an example from the 1880s that is wildly irrelevant to current medical practice to suggest that such decisions are currently directed by the pride, greed and apathy of physicians as they go about denying care to individuals they deem unworthy and quashing brilliant innovations. In fact, the profession of medicine is subject to a colossal number of checks and balances, which include scientific and evidence-based practices that are researched and practiced under intense peer review, as well as immense social control via the legal system.
The decision to terminate futile care, in particular, is not taken lightly. It is not made by individuals, but under the purview of ethics committees consisting of physicians, social workers, pastors, lawyers and others who come together to grapple with the complex issues that have to be addressed. Abeler and Hoffman propose that, instead, such decisions should be individual — that each of us should have the "right to try" any medical care we might wish would work and be allowed to mobilize societal resources to do so. This is far from a call for open debate. It is a proposal that completely short-circuits the very idea of communal decisionmaking.
Virginia Dale, Minneapolis
The writer is a physician.
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Abeler and Hoffman challenge us to respond to the life/death debate, as it seems there is too much confusion over medical science judgments, human rights priorities and even the innovative right to try. Obviously, not enough effort has been expended to encourage everyone to become educated and complete a medical directive, often to accompany their final will and testament. We need to promote this far and wide with guidelines and sample forms that will specify the detailed action plan should one become incapable of making life/death decisions for themselves. This should be a solid legal document reflecting the rational decisions of the individual. Perhaps these could even reflect different interventions at different ages — more at age 40, less at age 90.
Face it, we are all going to die irrespective of any science-fiction, cryonic attempts to rejuvenate. We were created to live out God's plan for us, and we must respect that plan, a time to live and a time to die. Modern medicine interventions can keep a body alive in some of the worst conditions imaginable. We can all give our doctors and loved ones the solace of a guilt-free legal directive of our intent, moving on to the farewell celebration of life.
