On December 23, 2015, a forty-six-year-old man named Chris Dunn died of complications from presumed (though unconfirmed) pancreatic cancer. In a few short months, illness ravaged this ex-sheriff’s deputy, his stout physique shriveling to skin on bones. In his final weeks, a breathing tube and ventilator were all that separated him from death.
I have no doubt that his physicians at Methodist Hospital in Houston, Texas, did everything within reason to devise a cure and, when that was deemed impossible, to provide pain relief and comfort care. It is worth noting that Dunn was uninsured. Thus, the hospital and physicians may have provided his treatment without compensation. So where is the controversy in this tragic story?
Under Texas law (the Texas Advance Directives Act of 1999), a hospital medical ethics committee can override a patient's or a family’s wish for continued life-sustaining care. Note the term “life-sustaining.” This case was not about unusually aggressive treatment done in a futile effort to achieve a cure. This was about providing the care necessary to sustain the life of this terminally ill patient until he inevitably died. In this instance, the essential elements of that care were a feeding tube and a ventilator (i.e., breathing apparatus).
There are circumstances in which the Texas law would serve a justifiable purpose. For example, if a patient has suffered irreversible total brain death and advanced medical equipment is the only reason blood continues to circulate through an otherwise deceased body, withdrawing medical support is justified under virtually any moral code.
But none of that applied in this case. As this video reveals, Chris Dunn was fully awake, cognizant (though unable to speak because of the breathing tube in his throat), and literally begging to live when the hospital ethics committee convened to decide his fate.
Death by Committee
This was not a situation in which doctors were up against the limits of medical technology, the treatment was causing significant harm to the patient, or the benefits of continued care had ceased. On the contrary, the technology involved in this patient’s care is commonplace, the patient wanted treatment to continue, and its benefit was obvious in keeping him alive.
Despite these facts, the committee voted to withdraw life-sustaining care. In other words, they voted to terminate Chris Dunn’s life. When his family resisted, attorneys for Methodist Hospital petitioned the court to appoint their designee as the patient’s legal guardian so that they could end his life. It is difficult to imagine a more malevolent perversion of the word “guardian.”
Having participated in many treatment discussions on behalf of terminally ill patients, I will readily acknowledge that patients and families sometimes have unrealistic hopes for a cure. However, acknowledging this possibility does not redeem a badly flawed law or vindicate a morally corrupt decision. In deciding to withdraw life-sustaining treatment from an alert and cognizant patient who so obviously wanted to continue living, the hospital and its ethics committee stole from him the two most fundamental rights enumerated in our Constitution: life and liberty.
No explanation was offered in the hospital’s letter to the family—just this terse statement: “[The Ethics] Committee has decided that life-sustaining care is medically inappropriate for Chris.” Given the confidentiality rules that govern medical committee deliberations, we will never know why the panel decided that this man did not deserve continued life-sustaining care. However, we know he was not permitted to have an advocate present during the committee’s deliberations, and he was denied any opportunity to appeal the committee’s decision.
Virtue Has Left the Room
A hospital spokesperson may have provided an important insight into the committee’s deliberation when he stated, “We feel strongly that every decision we have made is in the best interest of the patient.” This is a key concept. When faced with a conflict between the physicians’ treatment recommendations and the patient’s wishes, medical ethicists often invoke the “best interests” standard, weighing the potential benefits and burdens of a particular course of treatment. For patients with terminal illnesses, this standard often leads to the utilitarian question: Is the patient’s life still worth living?
In Chris Dunn’s case, the committee’s answer was “no.” Relative strangers with little or no knowledge of his values and beliefs weighed his “quality of life” and decided that he no longer deserved to live.
Consider the implications of this. According to the tenets of contemporary bioethics, exemplified here by Methodist Hospital, the weakest and most vulnerable among us have less value than the strong and powerful. Of course, each one of us who lives long enough will someday join the ranks of the weak and vulnerable.
The ethics committee members would undoubtedly argue that they considered many factors and at all times had the patient’s “best interest” in mind, just as the hospital spokesperson said. But that leaves unanswered the biggest question of all: How did these committee members who had only recently met the patient—if they ever met him at all—know that it was in his best interest for them to end his life?
On many occasions, I have watched anguished parents struggle to discern what is in the best interest of their terminally ill child—a child they have known since birth. Likewise, loving spouses often suffer the torment of not knowing what their partner of fifty years might want. But, somehow, we are to believe that these committee members were able to deduce existential truths about what was in Chris Dunn’s best interest?
The inconsistency of modern bioethics is breathtaking. On the one hand, if you want to end your chronic suffering or deal with a terminal illness by committing suicide, today’s utilitarian ethicists will invoke personal autonomy as the guiding principle and endorse your plans. But if you choose to continue living in spite of your suffering or terminal diagnosis, those same ethicists brush aside the notion of personal autonomy, label your request as unreasonable, and conclude that you are sadly incapable of making the “right” choice.
Under the traditional Hippocratic oath, physicians vow: “Whatever houses I may visit, I will come for the benefit of the sick,” and “I will keep them from harm and injustice.” For over two thousand years, physicians pledged to care for and protect the weak and infirm, and deeply imbedded in this covenant was the idea of equality. This case shows how far we have drifted from those precepts. Today, medical ethics committees go behind closed doors to decide whether a fully cognizant patient begging to live is worth the physician’s effort.
A Cultural Tipping Point
It is a morally impoverished society that would withdraw life-sustaining treatment from a dying man and steal from him any chance for spiritual serenity when he most needs it. It is worse still that this was done by a self-described “faith-based” organization. Under what precept of Christian faith does someone claim the authority to play God?
Chris Dunn died before the court battle concluded. We will never know if Methodist Hospital would have been awarded guardianship and, thus, empowered to withdraw his life-sustaining treatment.
What we do know is this: Modern bioethics has wholly abandoned America’s foundational concept of equality. Instead, each patient’s life is assigned moral value (or not) based on impossibly vague and relativistic criteria such as happiness, suffering, and “the common good.” In our not-so-brave new world, some human lives are worth more than others, and the inviolable dignity of human life has become passé.
Nearly four thousand years of Judeo-Christian tradition taught us that each human life is sacred and has inviolable dignity. Reason alone tells us that human life is special and we have a duty to protect one another. And that duty is especially strong when dealing with those in a weakened and vulnerable state. Once we abandon these values—once our society accepts a hierarchy or pecking order of human life—all of the rights and protections that follow from these luminous principles are lost.
As distressing and desperate as his final days must have been, Chris Dunn’s death will serve a noble purpose if it spawns a public debate and helps to rekindle a respect for all human life. I only hope it is not too late to restore the Hippocratic virtues that once reflected our nation’s highest ideals.
Philip Hawley, Jr, MD, is a hospice physician and former Assistant Professor of Clinical Pediatrics at University of Southern California Keck School of Medicine. His novel, STIGMA, was published by HarperCollins.