Life Support For Poor Trimmed By Senate Shrinking Health Care Dollars Collide With Cost To State Of Prolonging Life Of Indigent

Taxpayers shouldn’t pay to keep poor patients on life support that doctors believe artificially postpones death, the Idaho Senate has decided.

The Senate passed a bill last week that would add life support and incurable cancer care to the list of high-cost medical treatment the state no longer would cover under its catastrophic health care program.

While the bill now languishes in a House committee, the controversial move thrusts Idaho to the forefront of an awkward 5-year-old national debate: How and when should shrinking health care dollars be used to prolong life for terminal patients?

“It’s an uncomfortable issue,” said Steve Millard, president of the Idaho Hospital Association. “When you talk about money and you talk about life and death, it’s always uncomfortable.”

While it’s unclear if other states have adopted similar rules, medical ethicists say they expect to see more states make attempts in coming years.

“There’s no such law or rule in Washington, but it’s a political reflection of the futility debate,” said Johnny Cox, an ethicist with Spokane’s Sacred Heart Medical Center, who has led conferences on “medical futility.” “Our society has not come close to resolving it yet.”

The issue first arose in 1989, with Twin Cities resident Helga Wanglie. The comatose woman was not expected to survive or come out of her vegetative state, but her husband demanded she remain on life support.

Doctors argued in court that the resources could better be used to treat patients who had a chance of surviving. The court found in favor of Wanglie’s husband. Wanglie eventually died, still on life support.

Wanglie’s case focused on the question of who should make the decision, Cox said. But with the rise of managed care, the issue now often centers on cost.

“Is it appropriate to pour lots and lots of resources into someone when it will do no good?” asked Kootenai Medical Center Chaplain Luther Gutz, a member of a hospital ethics committee. “That’s the question.”

It’s what prompted the Idaho proposal, sponsored by Sen. Hal Bunderson, R-Meridian. He said it came out of efforts to reform the state’s $25 million indigent care program.

Currently, medical costs for poor people without insurance who are not covered by Medicaid or Medicare are swallowed by counties and the state. Kootenai County expects to spend $640,000 on it this year alone. The state takes over patient costs that exceed $10,000.

“These costs have no cap,” Bunderson said.

Life-support treatments can keep patients alive for months or years, and cost thousands of dollars a day. His proposal would help prevent costs from spiraling even higher, he said.

Before money for such treatment is cut off, two independent doctors would have to agree the patient was in a persistent vegetative state and would not recover. The state would not actually decide whether a patient is removed from life support.

“The burden would shift back to the hospital,” he said.

While the bill may “sound terrible,” Gutz said, it was appropriate for the state to set such guidelines. Doctors would make the final call - after consulting with family and friends - about terminating life support.

Sen. Mary Lou Reed, D-Coeur d’Alene, one of only eight legislators to vote against the proposal, disagreed.

“It’s clear what we’re talking about is who should live and who should die based on their ability to pay,” Reed said. “That pushes medical ethics off the conscience and into the checkbook.”

, DataTimes