“As of right now, his quality of life… he doesn’t have much of one.”
“What do you mean? Because he’s paralyzed with a brain injury he doesn’t have quality of life?”
“Correct.”
This was the conversation between a doctor at St. David’s Hospital in Austin, Texas and the wife of a quadriplegic man in early June. Michael Hickson, who was disabled due to an anoxic brain injury he had suffered in 2017, had been admitted to the hospital with a low-grade fever and pneumonia after testing positive for COVID-19 a few weeks earlier. Due to an ongoing custody dispute between Mrs. Hickson and her sister-in-law, a court had appointed Family Eldercare as Hickson’s temporary guardian and Mrs. Hickson no longer had the right to make medical decisions on behalf of her husband. In a recorded conversation between Mrs. Hickson and the hospital, one of the doctors treating Hickson explained that the decision had been made not to pursue further treatment and to instead put him on hospice care, and that this decision was made because of Hickson’s quality of life. When pressed on whether or not the quality of life assessment had been made because of Hickson’s disability, the doctor said that it was, and returned to that point more than once throughout the conversation, arguing that Hickson’s case was different from other patients, saying, “His quality of life is different from theirs. They were walking, talking people.” Six days later, Hickson died.
In the days since Hickson’s death on June 11, a Texas-based disability advocacy group, the Austin dioceses, and the National Council on Disabilities have called for further investigation.
End of life care is complicated and full of difficult decisions. The outbreak of a novel virus only adds to that as doctors navigate the unknowns of COVID-19. On top of that, for the sake of patient privacy protection, hospitals are rarely able to set the record straight without breaking privacy laws, meaning that an accusation can be made and in most cases, the hospital can do nothing except take the heat. However, given the recorded statements from one of the doctors involved regarding Hickson’s quality of life due to his disability, this case deserves further scrutiny.
Both St. David’s Hospital and Family Eldercare have issued statements in the aftermath, clarifying that, contrary to earlier reports, Hickson was not denied food and water, but had been placed on hospice. St. David’s explained that at the end of his life Hickson was no longer tolerating feedings and risked aspirating if they continued. The hospital also stated that Hickson was extremely ill when he was admitted and that there was nothing that could have been done to save him.
It very well may be the case that the hospital provided the best possible treatment to Hickson and that nothing further could have been done to prevent his death. Hopefully this is what happened. But the conversation between Mrs. Hickson and the doctor at St. David’s raises serious questions. The reason that the doctor gives in the audio recording for not pursuing further treatment is not the same as the reason given by the hospital in their official statement on Hickson’s death, nor was the doctor’s connection between Hickson’s disability and the decision not to pursue further treatment simply a one-time slip. He reiterated multiple times throughout the conversation that Hickson’s disability made for low quality of life and as such, further treatment was inappropriate. If the hospital did in fact make the decision along with Family Eldercare based on Hickson’s prognosis and multi-organ failure after making their best efforts to save him before he reached that point, then this is what should have been communicated to his wife. What was instead communicated and recorded was that the doctor did not see Hickson as having a quality of life worthy of further treatment because of his disability. The available evidence strongly suggests that at least one doctor involved in Michael Hickson’s care deemed Hickson’s life to be less worthy because he was disabled. Whether that doctor was speaking out of turn or accurately representing the hospital’s assessment of the value of Hickson’s life should be investigated.
Hickson’s death and the statements from the St. David’s doctor in Mrs. Hickson’s recording draws attention to the ethical concerns regarding “quality of life” based care. Speaking to the Washington Post about Hickson’s case, a bioethicist at Baylor University pointed out that people with disabilities frequently view their quality of life higher than others do, including some doctors, and that this can affect medical care, especially in states like Texas that have futility laws allowing hospitals to override a patient’s or families’ wishes regarding further treatment. Writing in First Things, Wesley J. Smith says, “the quality of life ethic is deadly. When doctors fail to recognize life itself as a good, and only deem as “good” those lives they perceive to be of sufficient quality, the weak and vulnerable are put at material risk.”
The value and dignity of an individual is not determined by their perceived quality of life but by the fact that they are known and cherished by their Creator whose image they bear. Michael Hickson was a husband, a father, and a brother, and his family deserves answers on whether or not the hospital really did offer him the same quality of treatment they offer to able-bodied individuals. The National Council on Disability is right in calling for a complete investigation in order to ensure that hospitals are not treating people with disabilities as less deserving of care.
