Perhaps they'd have more luck with the Monty Python approach.

Culture of Death: This one's dead.

Patient: No I'm not!

Culture of Death: Of course you are.

Patient: I'm not dead.

Culture of Death: Do be serious, you'll be stone dead in a moment.

Patient: I think I'll go for a walk.

Culture of Death: You're not fooling anyone you know.
Matthew Gardocki | 04.27.06 - 6:14 pm | #

This is horrendous. No insurance company has the right to decide whether someone's care is extraordinary or not and whether it should be drawn. If a living will states or a family wants to keep their loved one alive, no matter what state that person is in, the law should COMPEL the insurance company or hospital to pay for it. Screw their profits. Thats their job, if they can't figure out their finances, too bad. That choice belongs to a person's stated intentions or their family's descernment ALONE.

Its not just culture of death, its culture of Profit as God.
A W | 04.27.06 - 6:44 pm | #

I can't help but think about the scene in Monty Python's The Holy Grail in which a man is pushing a cart and screaming, "Bring out your dead"! A young man approaches carrying an older man who is saying, "I'm not dead yet" as he is stacked onto the cart. The younger man keeps trying to convince the cart-pusher that the old man is dead while the very undead fellow continues to protest. This goes on until finally the cart-pusher hits the heretofore alive man on the head rendering him dead and the two living fellows continue on their separate ays.

This might be a tasteless scene to pop into my head, but when Graham Chapman and Michael Palen wrote that scene, they meant it as FARCE. Now, it seems a little too real, if the facts that I've read are the truth.

I admit that I usually take the "culture of live vs. culture of death" rhetoric with a large grain of salt because it has seemed overly simplistic/dualistic in the past. However, this Andrea Clarke situation is really frightening to me. I will watch as this unfolds and hope/pray for her life.

Nathan
Nathan | 04.27.06 - 7:57 pm | #

Who are you calling the culture of death? The Republicans? Who support the insurance industry at all costs?

And really this was posted on the liberal commie daily kos in March,
and all across the political divide. [including a correction with an accurate description of the fact that the law signed by Bush made it more difficult to do this - a lot of the left claimed Bush made this possible] So it should be easy to get this legislated, right?

So tell me again, who is that supports the profit at all costs culture? Chickens coming home to roost?
zzzzz | 04.27.06 - 8:09 pm | #

"I can't help but think about the scene in Monty Python's The Holy Grail in which a man is pushing a cart and screaming, "Bring out your dead"! A young man approaches carrying an older man who is saying, "I'm not dead yet" as he is stacked onto the cart. The younger man keeps trying to convince the cart-pusher that the old man is dead while the very undead fellow continues to protest. This goes on until finally the cart-pusher hits the heretofore alive man on the head rendering him dead and the two living fellows continue on their separate ays.

This might be a tasteless scene to pop into my head, but when Graham Chapman and Michael Palen wrote that scene, they meant it as FARCE. Now, it seems a little too real, if the facts that I've read are the truth."

There's actually a disability rights group called Not Dead Yet, after the Python skit.
Patrick | 04.27.06 - 8:33 pm | #

The Culture of Death: Just enough of ME; way too many of YOU.
Clayton Barnett | 04.27.06 - 8:33 pm | #

This nasty case at least exposes the "cost-benefit" issue that is very much at the heart of euthanasia-by-foregoing-treatment. Who pays, how much they should have to pay, and what happens when there is no one willing or able to pay is are, in the end, THE crucial ethical questions. Have no illusions about this. It is already a MAJOR factor in decisions made by families and individuals themselves, and many, many people are denied treatment because famiies or they themselves don't want to deplete estates by incurring hospital and nursing home bills with ordinary treatment or care for the old, sick, and disabled. We have barely faced up to this at all, prefering to posture about abstractions and rhetoric over the "culture of death."

Never fear. The Great Debate on Health Insurance everyone is avoiding is unavoidable. If we want to keep people like Terri Schiavo and Andrea Clarke alive, then we're going to have to pay big time in taxes and/or insurance premiums. There is no way around it, and anyone who opposes paying one way or the other are the REAL proponents of the Culture of Death.
Celine | 04.27.06 - 11:20 pm | #

Any reason a Catholic hospital or hospice can't take her in?

(Besides the fact that Catholic hospitals are often Catholic in name only.)
Kevin Jones | Homepage | 04.27.06 - 11:21 pm | #

I said it in the other thread when this was mentioned, and I'll say it again: unless the terrorists get us first, WE ARE ALL GOING TO DIE LIKE THIS.

All of us will be murdered someday.
Sydney Carton | Homepage | 04.27.06 - 11:41 pm | #

St. Lukes is muted by HPPA laws until the patient or the family gives them permission to present the medical facts of the case. I wonder why the family has not given such permission. Until they do, I'm not credulous.

I thought Andrea might be locked-in, but the discription given by the family is not consistent with that syndrome. The woman has been hospitalized since November. Is it not possible that the family is reporting her condition as it existed 2-3 weeks ago, but not now? Alternatively, maybe the patient really wants to expire, and the family might not be willing to accept that.
John R | 04.28.06 - 12:08 am | #

Wesley J. Smith reports on his blog that Andrea Clarke's family has accepted the offer to move her to Illinois where she will receive treatment.
http://www.wesleyjsmith.com/
Marty Helgesen | 04.28.06 - 12:17 am | #

Kevin Jones has a good idea, asking why a (good) Catholic hospital or hospice wouldn't take her in?

Unfortunately, it is not at all clear that Catholic hospitals or hospices, whether "good" or not, would disagree with what St. Luke's (Episcopal) is doing. Have we read anywhere that there are Catholic ethicists outraged about this? Did the Archbishop of Houston demand that Andrea receive treatment in Houston-area Catholic hospitals?

Even so, I think that Jones is right: If this sort of thing is really wrong under Catholic ethics, shouldn't we demand (and put our money where our mouths are) that Catholic hospitals/hospices/docs provide people like Andrea continued treatment? What does it say that we do not?
Celine | 04.28.06 - 12:41 am | #

The problem with "cost/benefit analysis" is not that it is used inappropriately (which it is), but that it is used discriminately. If anyone recalls the (very) early Lukas film "THX1138" (from his license plate), pursuit of a "criminal" (i.e., someone attempting to buck the system) stopped the moment the computerized cost-benefit analysis showed that it was costing too much to pursue the malefactor.

If "the system" were to be implemented consistently on a cost/benefit analysis, without double standards for selected individuals, judges, juries, and all the little etc.s would be genuinely indifferent as to where the money came from to support even the most extraordinary of extraordinary care.

E.g., in the Schaivo case, as long as somebody somewhere was willing to foot the bill to care for her, the judge should have been completely indifferent as to who, or their motives. In this Clarke case, if the insurance company cannot be forced to pay a legitimate claim (I'd really like to see the insurance contract on this one), neither they nor the hospital should care if somebody else picks up the tab.

Programs to eliminate the physically, mentally and economically unfit rely absolutely on cooperation by and with the State. The Nazi program of euthanasia fell apart in Holland because the medical profession almost to a man turned in their licenses when it became a requirement to "report" all cases subject to "involuntary termination." (We will not go into the fact that the Dutch medical profession is now, ironically, in the forefront of everything their fathers and grandfathers rejected with contempt.)

There are two possible solutions to such systemic injustice. 1) Work for consistency within the system. The Nazis were experts at this. The French called Hitler "Adolph Legalite" for his great skill at manipulating the law to his own advantage. The Dutch medical profession was able to turn the tables on Hitler simply by adhering to the letter of the law. If reporting people for possible euthanasia is a licensing requirement ... don't get or keep a license. (Il Duce attempted something similar when Hitler demanded that he start rounding up the Jews. Mussolini told his subordinates to report to Hitler that it was being done, whereupon they asked, "So you want us to round up the Jews?" "No -- just tell him we are.")

2) Carry out acts of social justice designed to restructure the system itself so that it conforms to basic principles of natural law. That is, restructure the social order so that individual acts of morality (virtue, including justice) once more become possible or optimal.
A. Nonymouse | 04.28.06 - 8:22 am | #

We do not have any evidence that the decision to retreat, or withdraw the ventilator, is economically based. We only have the family accusation. I seriously doubt that the hospital/doctors hve looked at this case only from a cost/benefit standpoint, and then looked at a fully cognizant patient, who has an expressed a desire to live, and said, "we're going to kill you now."

If the Clarke's family reporting to the media is completely true and timely, then the hospital, doctors, and ethics committee deserve all the opprobium we can heap upon them.

But other scenarios are possible: (1) Clarke is brain dead, in which case withdrawal of medical devices is entiely appropriate, because you can't kill a dead person
(2) Clarke, who expressed a desire to live earlier in the course of her illness, has changed her mind. The family will not accept this.
(3) Clarke expressed a desire to expire, witnessed and documented in the record. She has since declined neurologically, thereby leaving her family as legal guardians, who will not accept Clarke's decision. The hospital, therefore is doing their fiducial duty to the patient, not the family.
(4) Perhaps the family completely misunderstands the progression of the illness, the physical exam findings and their implications (neuro exam in particular)and the purpose of medical interventions.Families in such situations are understandably quite emotional, commonly ignorant when it comes to complex medical questions, obtuse when explanations are attempted, and obstinately refuse to consider any possibilities beyond thier wish for a good outcome. Sometimes families are just wacked.
(5)perhaps the diocese, through "backchannel" sources such as pastoral care, realize that the case truly is futile, and are not willing to intervene.
(6) maybe the family's motives are not so pure


Since the only info on this are snippets in the blogosphere and news media, justice demands that we reserve judgement until all the facts are known.
John R | 04.28.06 - 9:17 am | #

As JR (sorry) points out, the facts are not in. Some of the possible scenarios would be invalid reasons ... but nobody can make a judgment until the facts are known.

Of course, then the problem becomes the usual legal finagling, but judges (well, some of them) are trained to cut through that sort of thing and get to the real issue. The family's *motives*, for instance, are irrelevant when addressing the issue of the *patient's* rights. What matters is whether what they propose is consistent with the demands of human dignity.

Oh, yes ... one of the demands of human dignity is that it not be offended by a presumed "right" to "die with dignity." Anybody who's ever seen death of any kind knows that death is not a matter of dignity; death is no respector of persons. You may meet your death with dignity (using a different definition of the word), you can prepare for it (which is what your life is for, for any religious believer), you can greet it kicking and screaming ... but, all the propaganda to the contrary, death is never dignified. It's death.
A. Nonymouse | 04.28.06 - 10:12 am | #

For a real kick in the pants, go read St. Luke's "Value's Statement." Nyuk. It's a real laugher in light of current events.

This is beneath contempt. This is horrible.
Rankinstein | 04.28.06 - 11:36 am | #

It is ironic how the slightest twitch that might impinge on the mass media (even anti-pornography laws frequently) brings out the big guns screaming about a "slippery slope" that will hamper freedom of the press. But where are anything but pea-shooters in the media when life issues are at stake?? (Actually,the media tone is usually "pull the plug!!!) In the meanwhile the slope leading to a Treblinka, Buchenwald, Auschwitz style of Dr. Mengele medicine grows slipperier and slipperier as the insurance companies and hospital bureaucracies liberally apply the grease.
Deacon John M. Bresnahan | 04.28.06 - 1:17 pm | #

I don't know where I learned of this article. It might even have been on the blog. However, it's worth reading (or rereading).

Carrots Don't Cry
by Rachel Ginsberg

http://www.aish.com/ spirituality...ts_Dont_Cry.asp
Marty Helgesen | 04.28.06 - 1:56 pm | #

That sentence was supposed to be, "It might even have been on this blog."
****
Marty Helgesen | 04.28.06 - 1:59 pm | #

You mean ... there are *other* blogs????
A. Nonymouse | 04.28.06 - 4:25 pm | #

The sad reality is that if Andrea Clarke's use of $10k per day could have been reduced to $5k per day, the insurance company might not have been pressing so hard for the plug to get pulled. If She could have been sent home with a respirator and had home care for $5k in capital costs and family care with daily nursing visits for $1k a day, this might have been a solution that the current powers that be would have accepted happily.

The holy writ that you keep somebody who is on a ventilator in the ICU does not come from any ethics book. It comes from the legal department that is terrified to put somebody on a ventilator on a normal floor for fear of multimillion dollar lawsuit. To avoid the suit, she has to be in a $10k bed. To avoid going bankrupt, the plug must be pulled because $10k beds can't be afforded forever.

But just remember, the cost of lawsuits is only in the bare cost of damages and lawyers fees, ATLA says so. All the while, people are dying because of the behavior modifications of the current legal regime and I strongly suspect that Andrea Clarke is one of them.
TM Lutas | Homepage | 04.28.06 - 9:00 pm | #

Mark,

Maybe I am missing something but your comment is awfully glib, and I was hoping for a little enlightenment on end of life issues. The issues don't seem all that clear to me in this case.

Many of us may have to make our own decisions about what constitutes futile care for ourselves or others, and I see no contradiction with Catholic teaching in refusing furhter treatment in many cases.
TomM | 04.29.06 - 12:21 pm | #

...the insurance company might not have been pressing so hard for the plug to get pulled.

Again, there is the citation of "facts" that are not verified or in evidence. I seriously doubt the physicians would "pull the plug" on a patient solely at the behest of an insurer. There is likely much more at play in this case than mere economics or cost/benefit analysis. To address the point about ventilated patients- there are hospitals that exist solely for the care of ventilator-dependent patients. The daily cost is much less than that for an ICU bed. There are 2-3 in the Houston area.
John R | 04.29.06 - 7:59 pm | #