[CREDIT WHERE DUE: Since he has delivered four updates and two follow-up posts, it is incumbent upon me to note that Mr. Kleiman is making a good-faith effort to clarify and correct some of the many problems in his initial post. For me to have diagnosed his problem as "illiteracy" (since deleted from the post title), or to have stated that he made a deliberate decision to "make stuff up" and "retreat to fantasy" was wrong and offensive, and I apologize. "Attack the idea, not the person" is one of my own rules, and I did not meet that standard.
Since I am neither a psychic nor a psychologist, each reader will have to rely on their own devices to guess just what process led to the many assertions unsupported by evidence that appeared in Mr. Kleiman's initial post.]
Meanwhile, over in the "reality based community", we see an interesting reaction to the Terri Schiavo story -
make stuff up post follow-up corrections. Well, it didn't seem to work on the bankruptcy bill, and the abortion debate is ongoing. We are curious to see whether the retreat to fantasy attempt to correct an erroneous post is effective here.
Mark Kleiman starts us off with this post comparing the Terri Schiavo case in Florida to two recent cases in Texas. Briefly, in one case, Sun Hudson was an infant with a rare genetic disorder who was kept alive on a respirator for six months before the hospital pulled the plug over the objections of the mother; the second case was that of Spiro Nikolouzos, a badly brain damaged and very ill 68 year old man.
Mr. Kleiman's theme is that right to lifers are hypocrites for rallying to Terri Schiavo's cause while ignoring these two cases:
Where, I would ask, is the outrage? In particular, where is the outrage from those like Tom DeLay, who referred to the withdrawal of Terry Schiavo's life support as "murder"? If it's appropriate to Federalize the Schiavo case, what about the people being terminated simply because their cases are hopeless and their bank accounts empty?
Hmm, their bank accounts are empty? No evidence at all is presented that the decision in the case of Sun Hudson was made based on finances; none of the newspaper accounts linked by Mr. Kleiman refer to the mother's insurance status at all. The entire basis for this accusation seems to be the comment made by the Chief Medical Officer at St. Luke's who said this, in discussing the Spiro Nikolouzos case:
"If there is agreement on the part of all the physicians that the patient does have an irreversible, terminal illness," he said, "we're not going to drag this on forever ...
"When the hospital is really correct and the care is futile ... you're not going to find many hospitals or long-term acute care facilities (that) want to take that case," he said. "Any facility that's going to be receiving a patient in that condition ... is going to want to be paid for it, of course."
Please note - he did not say that St. Luke's was terminating Mr. Nikolouzos for non-payment; this story makes the medical situation a bit more clear. Apparently St. Luke's had been turned down by over thirty institutions before finally finding one that would accept this patient; perhaps the CMO was caught by the reporter simply thinking out loud as to possible motivations.
In any case, no evidence whatsoever was presented that financial considerations played a part in the Sun Hudson case; we are curious to see how long this casual slur of the neo-natal intensive care team and of the ethics panel at the highly regarded Texas Children's Hospital remains uncorrected.
Mr. Kleiman asks, "where is the outrage", but the question is surprisingly easy to answer.
Let's see - hiding in plain sight is this Houston Chronicle story explaining the differences between the cases. Helpful headline - "Schiavo case differs from 2 situations in Houston".
In a futility case such as Sun Hudson's, in which the treatment team is seeking to stop treatment deemed to be nonbeneficial, if the ethics committee agrees with the team, the hospital will be authorized to discontinue the disputed treatment (after a 10-day delay, during which the hospital must help try to find a facility that will accept a transfer of the patient). These provisions, which were added to Texas law in 1999, originally applied only to adult patients; in 2003; they were made applicable to disputes over treatment decisions for or on behalf of minors. (I hasten to add that one of the co-drafters in both 1999 and 2003 was the National Right to Life Committee. Witnesses who testified in support of the bill in 1999 included representatives of National Right to Life, Texas Right to Life, and the Hemlock Society. Our bill passed both houses, unanimously, both years, and the 1999 law was signed by then Governor George W. Bush.)
In the Hudson case, the hospital ran through the statutory procedure, but decided nonetheless to get a court order authorizing withdrawal of Sun Hudson's ventilator support. The hospital undoubtedly had its own sufficient reasons for taking this additional step; the statute doesn't require a court order. Indeed, the statute was designed to keep these cases out of court, if possible.
So let's see - pretty much everybody got on board with what seemed to be a sensible compromise, and now, two years later, the right-to-lifers are being excoriated for working within a system they helped to design. Odd.
And are there other differences between Sun Hudson and Terri Schiavo? Well, Sun Hudson had a terminal disease, required artificial respiration, and was "sedated for comfort". Is being on a respirator painful? Was this baby's general condition painful? I can't say - yet, anyway. In any case, no one is arguing that Terri Schiavo is in pain.
So, in the case of Sun Hudson, medical ethicists weighed the case of a terminally ill infant in (possible) pain with no hope of recovery, and elected to suspend respiration - that is well within the guidelines of medical ethics set by the Pope, Protestant churches, and, if we can believe these Brits, the Jewish faith. Is anyone inclined to argue that all of these criteria are met in the Terri Schiavo case?
Where is the outrage? Where is the reality?
And HUGE PROPS to LeanLeft, who actualy delves a bit and realizes that Kleiman is making this up.
Now, do we have time for a betting pool? Will the Kleiman meme be picked up (a) MoDo; (b) Krugman; (c) both; (d) neither?
I say it is mentioned by both, by the end of the week.
UPDATE 2: From the Health Law Prof Blog:
The next day, the Chronicle reported -- misleadingly and even inaccurately, as far as I can tell -- that the patient's hospital cited "[a] patient's inability to pay for medical care combined with a prognosis that renders further care futile [as] two reasons a hospital might suggest cutting off life support." What the hospital's chief medical officer appeared to say, however, was that it would be difficult to find a hospital or other facility that would be willing to accept a patient with such a bleak prognosis who was also unfunded. Lack of funding was not cited by the CMO as a reason for his hospital to discontinue life-sustaining treatment.
What he said.
MEME WATCH: On Tuesday, the meme breaks through in the Times:
The Schiavo case resonated through the president's day as Mr. Bush found himself on the defensive against accusations from Democrats that his signature on the bill was inconsistent with a Texas law he signed as governor in 1999.
"Clearly there has been some hypocrisy here," said Representative Debbie Wasserman-Schultz, Democrat of Florida, who first raised the issue on Sunday on the House floor.
The Texas law allows a patient's surrogate, like Ms. Schiavo's husband, the right to make end-of-life decisions. But it ultimately gives hospitals the right to withdraw life support if there is no hope of revival, regardless of family wishes. Under the law, a critically ill 5-month-old was taken off life support and allowed to die last week in Texas, even though his mother objected.
White House officials said that Mr. Bush signed the 1999 law as a compromise over an earlier bill that he vetoed in 1997 as too onerous for patients on life support. The 1999 bill, said Thomas Mayo, a law professor who helped draft it, added several protections for patients, including a 10-day period that would allow families the time to find another hospital for a patient once the initial hospital decided to end life support.
MEMEWATCH II: Dan Froomkin of the WaPo picks this up, citing only Kleiman and Digby. We will e-mail him links to LeanLeft, the Healthlaw Prof (statute, ability to pay), the Houston Chronicle story, and yours truly - lots for him to ignore.
Try Mr. Froomkin at: email@example.com
LAST GASP: An update from Mr. Kleiman acknowledges some of these points.
TRULY FINAL: Mr. Kleiman acknowledges that money isn't everything in this post. Hmm - his two main points did not hold up well.