Wrong Medicine: Doctors, Patients, and Futile Treatment

6. Medical Futility in a Litigious Society

CHAPTER SIX Medical Futility in a Litigious Society One summer day in 1988, six-month-old Sammy Linares attended his last birthday party. In the midst of festivities, he choked on a deflated balloon. By the time his father, Rudy Linares, noticed what had happened, the baby was already blue and unconscious. Frantically, the father attempted mouth-tomouth resuscitation, then picked the child up and ran half a block to a neighborhood fire station for help. There firefighters managed to remove the balloon and continued efforts at resuscitation. But not until the boy was taken by ambulance to the McNeil Hospital emergency room were doctors and nurses able to reestablish the baby’s pulse and blood pressure. By then an estimated 20 minutes had elapsed between the baby’s asphyxia and the return of his own spontaneous heartbeat. For the remaining nine months of his life in the pediatric intensive care unit of the Rush Presbyterian St. Luke’s Medical Center, the heart continued to beat, but Sammy Linares never regained consciousness. Again and again physicians attempted to withdraw the ventilator, but the baby’s brain damage was too severe to allow him to breathe on his own. Reluctantly, the physicians concluded that the baby would never recover consciousness or survive off the 90 Wrong Medicine ventilator. At this point, Rudy Linares asked that the ventilator be disconnected so that his son could die in peace. All of the doctors and nurses caring for the baby agreed with the father that there was no point in continuing to keep the permanently unconscious body alive. But even though there were precedents, both in ethics and law, to allow withdrawal of life support under these circumstances,1 the physicians chose to seek the opinion of the hospital’s legal counsel. His response is worth recording : “What we are dealing with here is a legal problem.”2 Not a medical problem, a legal problem. This astonishing statement reveals how impoverished the notion of medical professional responsibility has become . Before agreeing to discontinue the ventilator, the hospital demanded that the Linares family obtain a court order. Why were the hospital authorities unwilling to go to court themselves if they truly believed in the appropriateness of the request and were simply seeking legal protection? The most likely explanation is that the best interests of the patient were overshadowed by the hospital’s concern for its own public image. The Linares family had already cost the state’s Medicaid program over a half million dollars. Wouldn’t the hospital be vulnerable to the tabloid press if it were sensationalized as a killer of welfare babies? Rather than risk its reputation, the hospital was prepared to keep the unconscious baby alive indefinitely. Meanwhile, Rudy Linares kept repeating his request that the baby be allowed to die in peace. Once, while visiting his son in the middle of the night, he disconnected the ventilator himself, but security guards wrestled him to the ground and the medical staff reconnected the machine. After nine months the distraught father took a more desperate step in carrying out his wishes. Following one of their visits, he sent his wife away and suddenly produced a gun. Holding the intensive care unit staff at bay and saying , “I’m not here to hurt anyone,” he disconnected his son’s respirator and waited for the boy to die. As proof that he meant no harm, he allowed the hospital staff to remove three other patients from the intensive care unit. Then, after confirming the baby’s death with a stethoscope that a physician slid across the floor, Rudy Linares surrendered to police. To the hospital administration’s astonishment, when the story reached the press they had so feared, the public outrage was directed against them—not against Mr. Linares. The state’s attorney filed a murder complaint, requiring Rudy Linares to undergo a psychiatric evaluation as a condition of his bond, but a grand jury refused to issue a homicide indictment. In the end Rudy Lin- Medical Futility in a Litigious Society 91 ares was found guilty only of a misdemeanor weapons charge. Indeed, many of us in the field of bioethics thought that the only crime for which Mr. Linares could be found guilty was practicing medicine without a license. For Mr. Linares, in his own clumsy, desperate way, was trying to do what all the doctors and nurses wanted to do...