Sun, a 6-month-old baby with lungs too tiny to breathe, was taken off a respirator at the Texas Children's Hospital in Houston earlier this month. He never would have been able to survive, even if doctors had continued treatment. But the decision to let Sun die was made by the hospital, over the objections of his mother, Wanda Hudson.
When the family wants terminal patients to continue treatment, and the hospital disagrees, the hospital's ethics committee has the final say. That's how it works in Texas, under a law passed in 1999.
The spirit of the law is not inherently cruel. It was designed so that doctors who felt it was wrong to prolong the suffering of terminal patients in obvious pain would be able to refuse treatment.
It requires that any case where the doctor wishes to remove life-sustaining care against the wishes of the next of kin provide 10-days notice, in which time the family must find another health-care facility that will treat the patient. But in cases where the patient is clearly dying, it can be hard to find a health care facility to take on that patient for the same ethical reasons that the original hospital wished to end care - so that they would not prolong suffering.
After 10 days, if the family cannot find another health-care provider, the hospital can discontinue life-sustaining treatment. In Sun's case, he was denied by 40 facilities with newborn intensive care units, according to the Texas Children's Hospital.
In a similar case, the family of Spiro Nikolouzos is currently suing to keep St. Luke's Episcopal Hospital in Houston to continue treatment of the 68-year-old, who is on a ventilator. Other than the aforementioned ethical considerations, the chief medical officer at St. Luke's told the Houston Chronicle that the ability to pay could factor into the life-or-death decisions made by doctors about whether or not to continue care to terminal patients. The lawyer for Nikolouzos' family claims this is part of the reason St. Luke's refuses to treat him.
In cases where patients cannot guarantee that they will be able to make the payments for medical care, it can be that much harder to find a facility that will treat the patient. It sounds ghoulish, but hospitals stay in business by providing medical care to people at a profit. And while finances may not be the deciding factor in whether or not to admit a patient, it certainly doesn't help when the money runs out.
While one can be sympathetic to doctors who feel the call to alleviate suffering is the highest priority, the right to determine life or death belong to the family, not to the physician, and not the hospital. Doctors should be able to refuse to treat a patient when the treatment only prolongs suffering, but not without first securing a physician that will provide treatment.
One can, as in the Schiavo case, make a compelling argument that family members should have the right to ask a doctor to end a loved one's suffering - but there is no reason a doctor should ever let an unresponsive patient die against his or her family's wishes.
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