Tuesday, July 7, 2020

Quadriplegic man’s death from covid-19 spotlights questions of disability, race and family

A Texas hospital deemed further treatments for Michael Hickson to be futile — a decision his wife opposed but others signed off on

Michael Hickson, 46, surrounded by his children at the nursing home where he had lived. Hickson died June 11 of complications from covid-19. (Family photo)
By Ariana Eunjung Cha

Michael Hickson, a 46-year-old father of five from Texas, was sick with covid-19 when doctors reached a crossroads in his treatment. He had pneumonia in both lungs, a urinary tract infection and sepsis — a dangerous immune response leading to multi-system organ failure.

He needed a ventilator to help him continue breathing, but the hospital felt further intervention for the disabled man was futile. A doctor explained to the family that there was little hope Hickson would survive or regain “quality of life.”

Hickson’s sister, a physician, agreed. So did the agency acting as his legal guardian. But his wife, Melissa Hickson, was horrified. She worried doctors were placing less value on her husband’s life because he was a black man who was disabled. After going into cardiac arrest in 2017 and suffering complications, he had been left quadriplegic and brain-damaged.

The disagreements over Michael Hickson’s care — amplified by an audio recording, widely shared on social media, of his wife pleading with a doctor to continue treatment — provide a rare window into fraught end-of-life decisions that are being made across the country as the novel coronavirus continues its rampage. The case puts a spotlight on issues of race, disability and family, including the different ways individuals, even within the same family, assess what makes a life worth living.

In the days after Hickson’s June 11 death, the audio recording shared by his wife has created a furor among disability rights activists across the United States who have rallied around his wife. Their outrage has been echoed by Catholic organizations and antiabortion groups, which have argued that stopping treatment was tantamount to failing to recognize the inherent value of a human life.

DeVry Anderson, chief medical officer at St. David’s South Austin Medical Center, where Hickson was treated, described his case as a “very sad and complex situation.” He said the decision to withdraw care was not a matter of hospital capacity, Hickson’s disabilities or cognitive abilities, or his race.

“This was a man who was very, very ill,” Anderson said in a written statement.

“Some people want the public to believe that we took the position that Mr. Hickson’s life wasn’t worth being saved, and that is absolutely wrong,” he added. “It wasn’t medically possible to save him.”

Hickson’s sister, Renee Hickson, a fellow at George Washington University Hospital in the District, said doctors worked very hard to save her brother’s life, but his decline was precipitous. She does not believe any of their decisions were based on his disabilities or his race.

“There is only so much medically that we can do,” she said. “And they did that for all of those days, and there was nothing more to do.”

In the recording between Melissa Hickson and the doctor in charge of her husband’s case, she expresses confusion as to how the decision to stop treatment was made and tries to change his mind. Under Texas law, such recordings are allowed as long as one party consents.

“So as of right now, his quality of life — he doesn’t have much of one,” the doctor explains.

“What do you mean?” she asks. “Because he’s paralyzed with a brain injury, he doesn’t have quality of life?”

“Correct,” the doctor responds. The hospital declined an interview on behalf of the doctor, who is not identified in the recording.

The debate over Hickson’s care has hit a nerve as crisis protocols activated by health officials in some jurisdictions would allow hospitals to ration treatments in certain circumstances, as coronavirus cases surge. Disability rights activists, among others, express alarm that disadvantaged groups — the disabled, members of minority groups, the poor — might get lower priority.

“I’ve been stewing on this for a few days as I try to come up with the right words to explain to you how much of an underlying fear this scenario is for much of the disabled community,” tweeted Steven Spohn, a popular gamer who has spinal muscular atrophy. “We live our entire lives in fear that one day a doctor will decide we just aren’t worth it.”

The Department of Health and Human Services’ Office for Civil Rights responded to such concerns this spring by probing some of the plans, issuing guidance affirming the need for nondiscrimination protections and threatening action against violators.

Devan Stahl, a bioethics expert at Baylor University, said research shows that people with disabilities often have a higher assessment of their quality of life than others do, including some doctors. That can adversely affect their medical care, Stahl said, and this bias has long been a source of controversy when it comes to medical futility laws in some states, such as Texas, that allow hospitals to override a patient or family’s wishes if they feel a treatment is not of benefit.

Stahl added that Hickson’s doctors may have been correct that he would not benefit from additional life-sustaining interventions, but it is “unfortunate that the physician stressed the quality-of-life judgment the way he did.”

“These are difficult things to say, and I want to be empathetic to physicians making hard choices,” Stahl said. “But I don’t think many are trained well enough to have these really sensitive conversations.”

Full Article & Source:
Quadriplegic man’s death from covid-19 spotlights questions of disability, race and family

No comments: