A little more on Baby Joseph

The current development on this story is that Baby Joseph has been transferred to a US hospital where a tracheotomy has been performed. The longer term objective is to transfer him home to die. So what should we say – or think about this outcome. If the procedure could be performed in the US why was it not performed here? Well, none of us were in the room when these questions were discussed but the course of events could have gone something like this:

The Canadian health care team believed that performing a tracheotomy with the sole purpose of sending the patient home to die was a cruel and unnecessary treatment. They believed that the patient would be harmed by the procedure which would bring no benefit to the patient. They believed that they have a commitment to the patient not to cause harm, in particular not to cause unnecessary harm. They understood that the parents wished to take baby Joseph home but they were not prepared to harm their patient in order to enable that to happen.

But if that is so how could another medical team come to the exactly opposite conclusion? How could they be prepared to perform the procedure? First, I think we need to assume that the baby’s medical condition has not changed, that is, the US health care team also believed that the purpose of the tracheotomy was to enable the child to return home. They would have to believe that the procedure could be performed without harming the patient and also that if that could be done it would be worthwhile doing it to benefit not the patient – but the patient’s family. I think they probably made a decision to perform the procedure on the child for the benefit of the family, believing that that could be done without harming the child.
How does that sound? Some commentators have accepted precisely that view. They have argued that if the procedure could be performed without causing suffering or discomfort to the child then why not perform the procedure to allow the parents’ the closure they so fervently desire. Why not “treat” the patient to heal the family?

What do you think?

I do think there is still something more to say. Even if the procedure causes no further suffering or discomfort I still have grave worries that it should be performed. “Treating” the patient to heal the family entails using that patient, that person, as a means to someone else’s objectives. It means using that person as a thing – an object to be, in this case, cut, to benefit someone else. I think, in practice, this is not uncommon. Think of the times an elderly patient is resuscitated, at the demand of the family, only to languish for days or weeks on life support in the ICU, only to die without ever having regained consciousness. All too often this is done – without there being any prospect of benefit for the patient just so the family can say – and feel “We did everything...” I think we can do better. I think we can make it far clearer that we have “Done everything” and that often merely keeping a person’s body alive – even if we have the technology to do so brings no real benefit. I think it is possible for good and loving families to work with their health care teams to do everything that might benefit the patient – but nothing that doesn’t.

What do you think?