One persistent feature of right-wing objections to fairly ordinary healthcare procedures is the unapologetic ignorance they display. The bizarre distortions of the debate over intact dilation and extraction abortions were just the most effective such example; from the Catholic Church’s completely false characterizations of condoms as a bulwark against AIDS, to the familiarly bogus claims about “the abortion/breast cancer link”, “post-abortion trauma syndrome”, and most recently James Dobson’s non-existent “detachment and differentiation” as the cause of homosexuality, the far right seems to suffer from a persistent and universal failure of reading comprehension, as well as a gasping lack of basic factual knowledge. And, worse, the use it to their advantage, often it seems deliberately.

The latest example is Pamela Hennessy’s screed against an end-of-life-decisionmaking bill in New Hampshire. She grounds a panicky call to arms on an obvious misreading of the plain text of the bill, then somehow manages to paint “ethics” itself as some sort of conspiracy (of the Party of Death, no doubt). You rarely see that much weirdness appended to one paragraph of legal text, but Hennessy - for years a Schiavo Foundation spokesperson (ahhh . . . now I understand . . .!) - manages it.

The bill (New Hampshire HB656) defines the procedure for validating and implementing a patient’s living will. It then includes this paragraph:

“IV. Nothing in this chapter shall be construed to condone, authorize, or approve (b) [sic] The withholding or withdrawing of medically administered nutrition and hydration or life-sustaining treatment from a mentally incompetent or developmentally disabled person, unless such person has a validly executed advance directive or such action is authorized by an existing guardianship or other court order, or such action is taken in accordance with the facility’s standard protocol as applicable to its general patient population.”

See if you can spot the tragedy lurking therein. . . . Give up? Hennessy found it:

Does that sound to you like the state of New Hampshire is concerned about your wishes? Or, could it possibly be intended to give a legal pass to hospitals who deny complicated patients ordinary care?

That small cluster of words can easily be construed to mean that a hospice ethics committee would gain the green light to do as they damn well please, whether or not you’ve directed differently. In sum, if they want to deny you treatment or care, they now have an out.

It’s interesting that this particular amendment does not suggest a determination from a doctor or a certification from two doctors are required before a hospital shuts you out. Only the facility’s protocol is required.

Obviously! When they said “nothing in this chapter shall condone . . . withholding or withdrawing . . . life-sustaining treatment from a mentally incompetent or developmentally disabled person”, what they really meant was there would be “a legal pass [for] hospitals who deny complicated patients ordinary care”, and that “a hospice ethics committee would gain the green light to do as they damn well please”. The fact that the passage only refers to life support for mentally incapacitated patients, and does not mention hospice, ethics committees, “ordinary” care, or “outs” or “passes” for anyone, does not matter. On the right wing, they can read the words that aren’t there. (Hennessy interprets texts like Bill Frist makes video diagnoses: “she sees things!”)

It’s not actually that confusing if you’ve been following recent events. The right’s latest conniption - or perhaps merely its newest trial-balloon “wedge issue” - is the concept of “medical futility”, the idea that some treatments which offer no benefit whatsoever may not be advisable even if the patient previously expressed a preference for them. Texas has a law - drafted by a coalition that included leading “right to life” groups, and signed by then-governor George W. Bush - that permits a care facility to terminate treatment, after observing a variety of procedural safeguards, when no qualified attending physician whatsoever can be found who believes continued treatment benefits the patient, and when the facility’s ethics committee concurs. This has been a useful source of organizational panic on the right, who have seized on the invocation of the futility protocol in several cases in which families were insisting upon lengthy and unavailing care for hopeless patients to generate a firestorm of hyperbole, falsehood, wild charges, and high-profile agitating. (In the most widely-publicized case, that of Andrea Clark, the family - eerily reminiscent of Terri Schiavo’s - kept insisting the patient was alert and talking, and was going to get better any day now, but that the hospital was deliberately conspiring to anaesthetize the patient to keep her from talking so they could kill her. When they finally found a doctor with National Right to Life who agreed - as literally no other doctor in the entire state could be found to agree - to aggressively treat the patient, the family joyously announced she was “getting better” and was “going to be all right”, thus proving that the finding of futility was false and immoral. Under the “pro life” doctor’s care, the patient was dead in four days. Determining exactly how much of their previous statements the family and their supporters then retracted is left as a very short exercise for the reader.)

Hennessy’s reference to “ethics committees” above makes it clear she is reading the text she quotes as a futility protocol. (She says so explicitly, and with her characteristic restraint, further down: “As far as I can tell, House Bill 656 would soften the path for facilities to impose cost containment and futility practices that rob you of your sovereignty and could leave you for dead.”) But it is obviously not that. The part she agitates about is the part that stipulates treatment may not be withdrawn “unless . . . in accorance with the facility’s standard protocol”. She seems to think this refers to a protocol for a futility determination. But the obvious meaning of the section cannot be that. For one thing, if these facilities already have futility protocols, there is no need for a statute invoking them; they could just go ahead and use the existing protocols. More importantly, the function of the statute is not to authorize any particular protocol; it is to ensure that whatever protocols regarding termination of treatment are invoked, are applied to mentally-disabled and all other patients identically. The prohibition on termination of treatment explicitly applies to mentally-disabled patients, and the exception clause (”unless . . .”) explicitly mandates “action . . . in accordance with the facility’s standard protocol as applicable to its general patient population.” It doesn’t say you can terminate treatment for anybody - nor does it say you may not. It says that your rules regarding termination must be applied without discrimination on the basis of mental disability. That is its only purpose.

OK - but what about those protocols? Maybe Hennessy doesn’t know what she’s talking about, but it still makes reference to protocols for terminating life support, right?

Yes. It tells facilities how to apply whatever rules they do have on that issue. Those rules, whatever they are, are for the facility to work out on its own, subject to New Hampshire law. (I don’t actually know the New Hampshire law on termination of treatment, or futility.) Whatever the law permits in that respect, it already permits. This new bill does not change existing regulations on that subject - it only mandates that they be applied equally. If there wasn’t an end-of-life crisis in New Hampshire yesterday, there isn’t one today, and there won’t be any new one if this bill passes.
But Hennessy’s on a roll, and when a right-winger has a head of conspiracy-theory steam up, you don’t just stand in the way:

Hospital ethics committees are not groups of doctors who interact with patients, families or caregivers of the patient. Rather, they are people who protect the legal interests of the hospital or nursing home, particularly when disputes over care arise. To a great degree, they mind the company store — not necessarily the customer.

Putting the power to end the lives of people they don’t know, based on cost containment practices or life quality judgments is not only an invasion of the patient’s privacy — it’s asinine.

Would you want a stranger, engaged in the business of protecting a hospital’s legal interest, deciding whether or not you should be allowed to live? Do you not think those decisions are best left to you and your family?

Like her previous rant, this is only partly as unhinged as it sounds. Hennessy here puts forward another of the “NG tubes for everyone!” crowd’s newest memes: hospital ethics committees are killing people for money. Ethics committees have been awkwardly amenable to the idea that not everyone’s care must be drawn out to the final extreme, irrespective of any other consideration. The right’s response, beginning at least with Schiavo but accelerated in the several recent futility cases, has been to attempt to paint medical ethics, and hospital ethics committees, as part of the conspiracy to kill patients that the right seems to find under every hospital bed. Since this is evidently absurd, a motive is needed - ah!, of course, they’re protecting the hospital’s financial health. The complete lack of evidence for this is, characteristically, of no concern. (This is not to say that the drain on resources of providing futile care is not a significant issue. It is very much so. Those resources include the extensive staffing required for many patients at end of life, the use of scarce equipment and other hospital assets, and the occupancy of scarce treatment beds by patients who cannot benefit from them. And the cost to the hospital of uncompensated care, especially for hopeless patients, is also an important concern. But futile care would be inappropriate irrespective of any of these issues, and finances are rarely the single motivating issue.)

In the highly-publicized Clark case, the patient’s care was fully reimbursed by insurance, yet no doctor, and no member of the hospital’s ethics committee, regarded it as other than futile. The fact that terminating treatment would have actually cost the hospital money made no difference to the many supporters of the patient’s family who stated outright the hospital was deliberately killing her for financial reasons. Also, the fact that hospital ethics committees invariably include a wide mix of clinical professionals as well as numerous members who are not paid by the hospital and some who are not on the hospital staff at all, and thus have no financial incentive to participate in a scheme of murder for profit, likewise has no significance to those who propound this wild conspiracy theory. And the fact that all such committees, and the clincial procedures they review, operate under the bounds of whatever state laws are applicable, also suggests nothing to the right wing about the likelihood of their theories. No . . . the Culture of Death is killing people through . . . hospital ethics committees . . . to reap the huge profits that come from not treating patients . . . ! (This sounds like the Underpants Gnome theory of medical conspiracy: “(1) Create an absurdly huge conspiracy founded on abstruse theories of medical ethics! (3) Profit!”)

This is a dangerous trend. It parallels the “right wing war on science”, and the general tendency among the right wing to treat rationality as optional. More than that - it is a deliberate attempt to remove rationality from the making of healthcare policy in general.

It hardly seems extreme to note that truly futile care should not be provided. The definition of “futile” partly depends upon patients’ values, of course, and strong autonomy advocates - I am one - recognize that as a first principle. But “autonomy” does not equate to a positive right to unlimited resources supplied by others, regardless of circumstances. No one recognizes such a right. No one, that is, except the right wing, when they’re talking about the right to take up other people’s resources for their pet causes. Then, the fact that there are good reasons why this is not a rational policy must not be faced. Conspiracy theories, wild and false charges, unrealistic - and in fact ungrounded - hopes, all are valid reasons for pursuing unworkable policies in defiance of the facts of practical cases. And to that end they are not only opposing, but attempting to discredit, ethics itself. They actually do not want a medical profession grounded on medical ethics- or, that is, they want one grounded on inflexible statements of position which they dictate and call “ethics”, while disparaging a rational and principled discussion of issues in light of facts. There is an active attempt ongoing to make “ethics” a bad word, and “ethicist” synonymous with “conspirator” - to counter the right wing’s utter failure to grapple with the issues on a considered basis. Thus ethics goes the way of science, fact-based discussion of sex, and other trappings of the reality-based community: inconvenient obstacles for the hell-bent right, and thus to be jettisoned by whatever means come to hand.