Medicine: Survival vs. Quality of Life

Getting Tough: Immigrants Deported by U.S. Hospitals, by Deborah Sontag, in today's New York Times, says, "Many hospitals are taking it upon themselves to repatriate seriously injured or ill immigrants because nursing homes won’t accept them without insurance."

The poor immigrants are sometimes grateful, willing to face reduced life expectancy in exchange for the gift of being able to go home.

Luis Jiménez, an illegal Guatamalan immigrant, suffered serious brain injury when he was hit by a drunken driver in a Florida car accident. Sontag says:

A community hospital saved his life, twice, and, after failing to find a rehabilitation center willing to accept an uninsured patient, kept him as a ward for years at a cost of $1.5 million.

What happened next set the stage for a continuing legal battle with nationwide repercussions: Mr. Jiménez was deported — not by the federal government but by the hospital, Martin Memorial. After winning a state court order that would later be declared invalid, Martin Memorial leased an air ambulance for $30,000 and “forcibly returned him to his home country,” as one hospital administrator described it.

Since being hoisted in his wheelchair up a steep slope to his remote home, Mr. Jiménez, who sustained a severe traumatic brain injury, has received no medical care or medication — just Alka-Seltzer and prayer, his 72-year-old mother said. Over the last year, his condition has deteriorated with routine violent seizures, each characterized by a fall, protracted convulsions, a loud gurgling, the vomiting of blood and, finally, a collapse into unconsciousness.

Many people will instinctively want to find the bad guys in this situation - the hospitals, the various governments, the illegal immigrants, their lawyers - but casting villains just short-circuits the genuine work of understanding the problem. I think when you see a story like this about people that you know are, on the whole, trying to act constructively, it can help you realize that pointing fingers isn't a good thing to do generally (as Jesus taught.)

Through legal action on Mr. Jiménez 's behalf, Sontag says, a lawyer, a paralegal, a priest and a bioethicist traveled to the Cuchumatán Mountains of Guatamala to assess his options. But the team "reached a conclusion that surprised them: There was no real compelling reason to think of bringing him back to Florida.”

“The first striking thing was his disposition: He was very, very happy,” said the Rev. Frank O’Loughlin, who pastored migrant workers in South Florida for decades. “Then, the second thing, he was well cared for.”

Sontag quotes team member Marnie R. Poncy, who is a both a nurse and a lawyer: "His quality of life is better than it would be in an American nursing home.... But I hazarded a guess that his longevity of existence was probably severely curtailed."

I gather this is the classic trade-off. Western medicine and the law around it seem to aim at extending life expectancy, even at the expense of quality of life, until someone is considered ready for hospice care.

I think a very large number of ordinary people would like to give more weight to quality of life, even when they know the consequences for shortened life expectancy, but their individual wishes currently have no avenue to reach a critical mass legally compelling enough to change the obligations that health care institutions, and the courts, feel bound by.

The ordinary peoples' lack of a voice in this is not because lawyers or anybody else are being evil, it's just the way our institutions have historically evolved. I think peoples' wishes in this respect, to have medicine focus more on quality of life, will be better heard as they support organizations and publications and laws that advance a spiritual, rather than a material, point of view.

Churches and other religious organizations probably have to be in the forefront of any successful movement in this direction, because the churches have a better chance of not being branded as "Kevorkian."