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COVID Stories: Decisions to Treat and the Quality of Life

In June of this year, Michael Hickson, 46, who had three years earlier suffered a heart attack which left him a quadriplegic, was denied food and water by medical professionals who judged him to not “have much of” a quality of life. He died on June 11th at St. David’s South Austin Medical Center in Austin, Texas.

His story is tragic, and complicated [1].

Not only was he disabled and with a serious brain injury, but he was ill with COVID which lead to additional complications including pneumonia and sepsis. Further, due to his brain injury, he had been declared incapacitated with decisions concerning his care relegated to his guardian; however, his wife and extended family were involved in a dispute over guardianship, and a third party, Family Eldercare [2], served in that capacity. And he was very ill, with no guarantee [3] of recovery. Consequently, against his wife’s wishes, he was transferred to hospice where it was determined that no additional care or treatment would be provided, not even hydration.

Despite the complexities, the case is shocking, particularly the exchange between Michael’s wife and a physician, in which it appears that treatment for COVID and its complications were refused not because treatment was unlikely to succeed, and not because it was a triage situation with limited resources or an overburdened medical staff, but because even if Michael recovered from COVID he would still be a quadriplegic with a brain injury. In the transcript [4], a doctor suggests that providing care would be “futile” and would not “improve anything.” His wife asks for clarification, “What do you mean? Because he was paralyzed with a brain injury, he doesn’t have a quality of life?” To which the physician responds, “correct.”

The doctor is not suggesting that treatment for COVID is futile, but rather that Michael Hickson himself is futile, that he is not worth treating for COVID because he doesn’t have quality to his life, because he was disabled. And so Michael was sent to hospice [3] where, “every effort was made to make the patient comfortable,” but all other treatment and assistance ended.

This is not the only tragic story involving COVID. Many have died alone [5], without the companionship of family or clerics, or not allowed to remain at home [6], and there are other anecdotal reports of cases similar to Michaels, of COVID serving as the putative reason for patients being transferred or treated, or not treated, despite the wishes of family.

Again, these stories are complicated. What is not complicated, however, is the value of the human person. Each and every human, from the point of conception to natural death, is intrinsically and fundamentally a person. What some term “quality of life,” while obviously important to our experience and satisfaction with life, is nonetheless irrelevant to the value of a human.

In philosophy we distinguish substance from accident. A horse differs from a giraffe because they have different natures, different substances, but that one horse is chestnut while another is white is accidental to being a horse. A triangle is a three-sided figure with internal angles equaling 180 degrees, in its substance, while it is accidental if the triangle is drawn in red ink, blue ink, carved into stone, or made of pine. Triangles are triangles, and humans are persons. Whether persons can walk, or talk, whether they are brilliant or dull, rich or poor, matters not a bit to whether they have value as a human being.

In the same way, a healthy, young, able-bodied man may have a better “quality” to their experience than Michael Hickson, a man severely disabled. They have different experiences, the quality of those experiences differ, but the quality of their lives—the worth of their lives—differs not at all, for their substance, their being-human, is the same.

Behind the push for euthanasia, assisted suicide, “mercy killings,” and the refusal to treat Michael Hickson—refusing even to provide him hydration!—is a very basic, but utterly damning, philosophical mistake. Namely, no one is more or less human than anyone else, even if they cannot walk or speak—for speaking and walking are not the substance of humanity.

If we continue to make this obvious mistake, there will be many, many Michael Hicksons in our society, and to our great shame.