Wednesday, April 06, 2005

The Need for Something In Between

During the recent Terri Schiavo case, more than a few people complained about government getting involved in private matters.

While I can easily agree that the federal government should have stayed out of it, I don’t see that it was simply a “private” matter, either.

For one thing, the public was paying for Ms. Schiavo’s care and therefore has a legitimate interest in how the money is spent.

For another, the issue was seen as one of extinguishing a human life and society clearly has a stake in defining the circumstances under which that can be done.

Which poses the question of who should be involved in resolving such matters and how they should go about doing so.

Certainly the patient (to the extent able to participate) and the patient’s family should have the main say, as long as they stay within the bounds of the law. When this group finds itself in dispute, the courts will have to decide.

But I think there is also a role for the health care establishment. In the case of Ms. Schiavo, I am somewhat disappointed in retrospect that the hospice that was caring for her (including its medical staff) didn’t speak up. Who better knew Ms. Schiavo in her debilitated state and who was better qualified to reach a judgment that took all of the competing considerations into account and to represent the community’s point of view? As a remote but interested observer of the case, I would have placed a good deal of stock in what the hospice had to say about it.

We like to say that health care decisions should be left to the doctor and the patient but that is no longer realistic. The community has too much of a role and too large an interest in what happens. So there is a need for a representative agency that reaches informed judgments from a community perspective that is broader than that of the necessarily self-interested individuals involved but more local and flexible than is permitted by the impersonal legalities of government.

Private, community-based health care institutions are ideally suited to play that role and we ought to insist that they do so.

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