Medicine's obligations

January 14, 1991

It is the exceptional cases that put rules and guidelines to the test. Facing that rare exception -- a husband who is adamant that his wife be kept alive against all medical and ethical advice -- a hospital in Minnesota has made news by going to court to ask permission to discontinue futile treatment of 87-year-old Helga Wanglie. The hospital's case is a strong one: Physicians and nurses there do not believe they should be forced to render medical care they consider inappropriate and that cannot be considered to be in the patient's best interests.

For eight months, Mrs. Wanglie has been in a persistent vegetative state, unable either to breathe or eat without the aid of medical technology. Physicians at Hennepin County Medical Center in Minneapolis see no hope of any improvement in her condition, and the hospital staff, including its ethics committee, feel strongly that continued use of medical technology will do nothing but further prolong her dying.

Any decision to refuse or receive treatment must include a consideration of the goals of medical care -- to promote health, to relieve suffering and to prevent an untimely death. Helga Wanglie's death would not be untimely. However much her family wishes to deny them, the facts in this case indicate that her life, in any meaningful sense, is over.

Money and the allocation of health care resources are not the direct issues here; Mrs. Wanglie's costs are covered by private insurance and the hospital is in fact profiting from her stay. (Of course, the costs of her care will weigh on other policy-holders.) Rather, the salient issue is whether health care in this country will be guided by an ideology that places an absolute value on "life" in any form, sustained by any means; an ideology that, in practice, perpetuates the ancient sin of denying human mortality.

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