Life at All Costs Decisions

Rosemary Flanigan

April 7, 2010

Back in October, we had an interesting exchange about “Saturday Morning Postmortem” which appeared in the Hastings Center Report last Sept/Oct. and I used it in my two ethics brown bag sessions.

If you recall, it was a case of a seventy-one-year-old woman who had been in the surgical ICU for eleven days following treatment for a small bowel obstruction. She had often told her husband (her surrogate) and countless care providers during her stay that she’d rather “die than have a colostomy.” The expedited ethics consult consisted of a junior faculty member and a graduate student/ethics fellow, members on call of the ethics committee of a large teaching hospital.

Remember that the husband had consented to surgery which would result in her having a colostomy because he understood that she would live with “the bag” only a few days. But their investigation revealed that the husband had misunderstood; they clarified the wife’s prognosis with her husband who then called the daughter and stopped the order for an operation. The woman died two days later.

In the current issue of Hastings Center Report, three well-known names sent letters to the editor: Felicia Cohn, UCIrvine, Mark Aulisio, Case Western, and Kansas City’s own John Lantos.

All three delivered a blistering review of the consult, but it is John’s question I wish to explore here: If the husband’s rescinding his consent to surgery was based on a misperception of reality (his wife’s reason for never permitting a colostomy—because it stank), can it truly be autonomous?

Many consults attempt to clarify the “life at all costs” decisions made by surrogates, says John; ought now the husband/wife’s misunderstanding of ostomy care have been equally explored?

The authors admit in a “reply” that “[W]e wonder to this day whether a truly autonomous decision is ever possible. . . .”