I have written about the Margot Bentley case before, and bring it up again because I think it may be the most important bioethical litigation now pending of which I am aware. At stake is whether a nursing home can be forced to starve a patient to death by withholding spoon feeding. From the Vancouver Sun blog post by Pamela Fayerman:
The suit is filed against operators of the nursing home (Maplewood Seniors Care Society), Fraser Health Authority and the government. Bentley’s living will, drafted, signed and witnessed in 1991, almost a decade before she was diagnosed with Alzheimer’s, states that she does not want “nourishment or liquids” if she suffers from an incurable disease.
Bentley’s husband, John, and her daughter, Katherine Hammond, contend that Margot’s wishes are being ignored since nursing home staff are spoon-feeding Bentley, an 82-year old former nurse who has been in a vegetative state for three years.
Bentley is voluntarily swallowing. No one is forcing food or water down her throat.
That point aside, I can hear you asking: “Wait a minute, Wesley. People can refuse feeding tubes in an advance directive. How is this request any different?”
I am glad you asked. Feeding tube cases are not technically about intentionally starving and dehydrating the patient — although that is certainly the consequence. Rather, the legal pretext allowing people to have tube feeding withdrawn or refused arises out of the general right to refuse unwanted medical treatment. Feeding tubes are deemed medical treatment in that they involve minor surgery and the formula provided has a medical component.
But in this case, none of that applies. Spoon feeding is not a medical treatment. It is basic humane care.
Bentley may have asked for humane care:
In a surprising development, the defendants have filed in BC Supreme Court an undated, second living will, purportedly signed by Bentley. Although it states that she doesn’t want to be a burden to her family and doesn’t want any treatment that “has no benefit other than a mere prolongation of my existence” it also states:
“I accept basic care however and request aggressive palliative care, drugs or any other measures to keep me free of pain or distress, even if they shorten my life.”
Whether she did make such a request or not, should make no difference! There is — or should certainly be — no right to refuse basic care. Patients and families should no more be permitted to force a nursing home to stop providing patients food and water than to force them to not provide proper hygiene, turn to avoid bed sores, or give patients beds and blankets!
If the plaintiffs win this case — and given ever-present issues of inheritance, cost containment, and a general disdain for the dependent involving elderly — one need not have a vivid imagination to understand the potential for naked abuse and abandonment of these vulnerable patients.
And that’s why I think this is the most important litigation involving bioethics pending today.