Ethicist alarmed over how treatment decisions were made for quadriplegic

The death of Michael Hickson, a 46-year-old quadriplegic, inside an Austin, Texas, hospice in June, pricked the conscience of Charlie Camosy.

Camosy is an associate professor of theological and social ethics at Fordham University in New York, and for most of his academic life, he has waged a quixotic battle against often-hidden cultural forces that, except for the pandemic and the scrutiny it has focused on medical decisions, might have gone unnoticed.

Hickson, an African American with a serious brain injury, was hospitalized with COVID-19 at St. David’s Hospital South Austin. Despite his cognitive impairments, his wife, Melissa, said he could solve math problems and play trivia. His physical condition admittedly was grave. He was receiving food and water through a stomach tube.

Shortly after being admitted to the hospital, a family dispute over the course of his care ensued, which resulted in the power to make those decisions being given to the state and the hospital’s medical team.

While Melissa wanted Michael to continue to be given food and hydration in the ICU in hopes that her husband could beat back the disease, his doctor told her any further medical intervention would not improve his “quality of life.” The medical team and the state had determined that only hospice care would be offered.

On her own, Melissa secretly recorded a conversation she had with the doctor, which is legal in Texas. Melissa did not want her husband intubated, which involves inserting a tube through the mouth and into the airway so a patient can be placed on a ventilator to assist with breathing. But she did want him to be given food, water, oxygen and medicine to give him any chance to improve. Certainly, that could not be considered burdensome treatment.

The doctor remarked that any aggressive treatment would not “help him improve anything” because “as of right now, the quality of life … he doesn’t have much of one.”

Melissa was shocked by that answer.

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

“Correct.”

The doctor went on to tell Melissa that he had cared for three other patients who survived in Michael’s condition, but he qualified that by saying Michael’s case didn’t “fit those three.” The defining difference, the doctor told Melissa, was that his “quality of life is different from theirs. … They were walking and talking people.”

But the medical panel had made its decision. Michael died of pneumonia six days after the withdrawal of nutrition and hydration had weakened and then stilled his body. He left behind a wife and five kids.

This was not a case in which the hospital faced a shortage of beds during a grave moment of the pandemic. It was a case, Fordham’s Camosy said, of euthanasia, pure and simple.

“According to the Catholic moral theological definition of euthanasia, it’s an act or omission which aims at death,” Camosy said. “Any time there’s a ‘quality of life’ judgment made — where it’s not the burden of the treatment — that’s a concern. Even his wife didn’t want him to be intubated.”

“The doctor thought that what made him different from the others who survived is that they were walking and talking,” Camosy explained. The doctor had every chance to say, ‘He’s just too sick, he’s not going to recover, there’s no point.’ No. He specifically mentioned three others in his situation … and what makes them different is they were walking and talking, and he was not.”

Melissa has used social media to raise attention over what she believes was unfair treatment of her husband decided on by the hospital with approval of a court-appointed legal guardian, Family Eldercare. She claims her husband was “murdered” and feels the doctor wouldn’t treat him because he was disabled.

Dr. DeVry Anderson, St. David’s Chief Medical Officer, in a July 2 statement said “misinformation” has been spread about the case and claimed “it wasn’t medically possible to save” Daniel.

In his book “Resisting Throwaway Culture,” Camosy writes that very often language and practices are employed “to hide, to throw away people from us so we’re not confronted with them.”

Viewed through the lens of over 143,000 COVID-19 deaths in the U.S. and global economic paralysis, it is difficult to imagine anything positive emerging from these past seven months. However, Camosy says tragedy has a way of creating a thunderclap of conscience.

“If there’s a silver lining in this pandemic, it has forced us to look — and now the question is, will we do anything now that we’ve seen?” Camosy told the Clarion Herald, newspaper of the Archdiocese of New Orleans. “The medical community is very good at not allowing public scrutiny of these kinds of situations.

“But, anecdotally, from what I saw on social media and from the people who emailed me or otherwise got in touch with me after they saw my social media posts, plenty of people have said, ‘This was me.’ ‘This was my cousin.’ ‘This was my wife.’ They were very dramatic statements about this not being an isolated situation.”

As the pandemic began, Camosy’s was among the first voices crying out when several states, including New York, ordered elderly COVID-19 patients who did not need ICU care back into nursing homes, which led to an explosion of cases amid the most vulnerable population possible.

“Fifty percent of people in nursing homes have some kind of dementia, and dementia is listed as one of the most important co-morbidities for populations to be worried about,” Camosy said. “The idea that we would send thousands and thousands of COVID-positive patients into some of the worst spaces for the spread of the disease — where the most vulnerable patients are — was just an unbelievably terrible decision.”

Camosy believes the church can step up during the pandemic by offering its empty schools and convents as places where the elderly can be safely housed and their dignity respected.

“Especially, as the culture gets older, it would be a fantastic way the church could respond,” he said.

Camosy said another way to honor the dignity of the elderly is to pass legislation that would help families care for their aging parents in their homes.

“That would be ideal, especially in a pandemic,” Camosy said. “We’ve now realized how important it is to keep people at home. That’s another problem of the two-parent income trap. We just have so many people who need to work that taking care of loved ones is really difficult at times.”

At 45, Camosy is in his 13th year of teaching at Jesuit-run Fordham, and he has thought deeply about how to enlighten his young, job-directed students with thinking that is foreign to them: The value of a human being cannot be based on utilitarian calculus.

“I don’t think kids get it, because at a place like Fordham — and in the Northeast in general — the kids have been largely trained by their parents and the culture to just achieve, to make goals and achieve goals,” Camosy said. “And so, that means, ‘Go wherever is necessary, even if it means moving across the country.’ That means their parents have to figure it out. Often, it’s the parents who are pushing and saying, ‘Don’t worry about me. Go live your dreams.’”

He added, “I wonder if we could have a countercultural message as a church about ‘localism,’ about putting down roots, and having multiple generations of family around to help take care of each other, especially as we age, and maybe a little less focus on telling our kids they can be and do whatever they want.”

Finney is executive editor/general manager of the Clarion Herald, newspaper of the Archdiocese of New Orleans.