Occasionally when discussing horrors like this (the recent news of dehydration of infants and children in the current UK medical system), one will run into a liberal troll, who supports both the dehydration killings and a socialized medical system, who confidently pronounces, "If these people want their children to be kept alive, they are certainly free to pay extra for it and go to a private hospital instead."
There are many, many things wrong with this response, but as surely as God made little green apples, you will run into it somewhere, some time, if you point out the evil of these killings.
The first and easiest thing to point out that is wrong with this response is that it is probably factually false. Aside from the fact that private institutions may be prohibitively expensive, what evidence does the chipper leftist actually have that patients are not dehydrated to death in private hospitals? As far as I know, no evidence at all. The assertion is simply made. Considering the fact that hospitals all over America have been dehydrating patients to death for quite some time in a non-socialized system (even before Obamacare came along), the prospects for this assertion aren't terribly good. The bald statement that if only these folks would pony up they could get their relatives fed seems merely to make the liberal feel that he has racked up debating points, especially as it's allegedly some sort of "score" against a pro-life opponent who also thinks socialized medicine a bad idea. It does not appear to be based on evidence.
I think we can say with a great deal of confidence that the families of patients in the NHS are not being told, "Hey, for an extra twenty thousand Euros or so, we'll keep feeding your child/parent/spouse." In fact, that would, I think we can guess, be regarded as bribery and corruption (and would be so regarded with some plausibility). So the statement, "If they'd pay for it, they could avoid this outcome" is not only shockingly bad ethics but also, very probably, false.
Let's consider a few more things wrong with this liberal response:
--The alleged rationale for a socialized medical system is that medical care is so important that it can't be left to the market, lest people fall through the cracks and not get what they desperately need. Leaving aside the very serious economic problems with this claim, if feeding and hydrating your patients while they are in the care of the socialized system isn't on the list of provided services, what's the point? Why take on a patient at all if you don't intend even to provide him with the most basic and therefore desperately needed care? Any system that is providing some people with IVF treatments (which the NHS does) but dehydrating other patients to death has a major problem of priorities and has no standing to bill itself as compassionate or as meeting fundamental needs. It would be better not to take responsibility for a patient in the first place (which is getting around to the title of this post) than to take responsibility for him and then deny him the bare necessities of life when he is at his most vulnerable. Food and water are not outlandish treatments but basic care. No medical system can have credibility qua medical system if it is dehydrating its patients to death, because such a system is simply not caring for its patients, period.
--Feeding and hydrating patients is not extravagantly expensive in itself. I strongly suspect from the sheer scale of the use of the Liverpool Care Pathway that a large number of the patients being killed in the NHS actually could eat by mouth. (Compare Pastor Joshua's case in Canada.) So there we are simply talking about feeding by spoon, giving fluids, etc., in a natural way. An NG tube, if needed, is very low-tech and hardly a large expense. And even if something like a PEG tube needs to be put in place, this is relatively minor surgery and can even be maintained by family members after the fact. Actually, tube feeding can provide a monetary savings over feeding by mouth, because it is less labor intensive and more efficient for nourishing and hydrating the patient, especially when the patient is an adult or older child and requires fairly large quantities of food. The repeated implication that feeding and hydrating disabled and/or dying patients is some sort of vast expense is simply bogus.
--A related point is that what is expensive, especially in a patient that is comatose long-term, or in an elderly patient who will live for some years more, is not the feeding and hydration itself but simply the general nursing care, continued over a long term, of the patient. In other words, it isn't that getting food and water to the patient is expensive in itself. It's that it costs money to continue (darn it) caring for the patient at all if he doesn't have the decency to die. It's the life of a disabled person who cannot care for himself that costs a lot in terms of daily care. But once we admit this, then what we have to admit is that patients are being dehydrated to death not because getting them the bare necessities of life is in itself extraordinary care, excessive, "keeping them alive on machines," or anything of the kind, but because the system doesn't want to keep caring for them at all. In other words, it then becomes evident that the very intent of withdrawing the food and water is that the patient should die, because disabled people take a lot of care! But in that case, the references to money and expense, which give the specious impression that families who don't want their loved ones dehydrated to death are asking for something intrinsically unreasonable, are a smokescreen. What is really being treated as unreasonable is that the families don't want their loved ones bumped off! And what is being suggested is that they should be required to pay through the nose to ransom the lives of their loved ones, who in a "rational" system would be purged out of the system because their very existence and need for basic care are a drain on the rest of us. Once one realizes that, one should laugh in the face of anyone promulgating this approach while characterizing conservatives as heartless.
--While part of the motive for dehydrating patients to death is system-wide cost savings, it does not follow that patients or their families are given any other option "if they can pay." In fact, the up-front rationale for dehydrating patients to death is what Wesley J. Smith calls "futile care theory." Futile care theory holds that if a patient is not expected to recover to the point that his life is considered worthy of life by the technocratic ethicists, then it is not rational to continue giving him what he needs to live. The sooner he dies, the better. Of course, this is all wrapped up in vague talk of "medical futility," but that's what it comes down to. Given that this is the case, this up-front rationale is not going to be withdrawn simply because a wealthy family member is willing to pay for the "extra" expense of feeding his loved one. The claim, in fact, is that it is wrong to continue feeding and hydrating the patient, that it is against medical ethics, that it is medically and morally inappropriate. That is how it is presented to patients and families. That is what the medical profession tells itself. That is, in fact, precisely how the medical profession avoids the cold-hearted sound of saying, "We want you to die now, because we just don't want to be bothered with you anymore." Instead, an elaborate medical ethics rationalization has been developed, and, believe me, that rationalization has a life of its own. That explains the fact that Zach McDaniels in the U.S. was nearly dehydrated to death on the basis of a "medical futility" judgement by a hospital death panel, despite his family's ability to pay through insurance for his continued care. This explains the judgement in the UK, in response to Leslie Burke's attempt to gain reassurance that he would not be dehydrated to death later against his will, that doctors should be able to cut off food and water to patients even against the patient's wishes.
When a patient is on a pathway to death, this is all orchestrated very carefully within a medical ethics framework that is meant to allow everyone to accept what is being done. It is not a matter of saying, "Oops, sorry, you ran out of money, now we can't help you anymore. You're on your own. Do what you want." On the contrary, even when infants are sent home to be killed by dehydration, it is still orchestrated, to make sure the infants do not get hydrated! These patients are being carefully and deliberately ushered out of this world because that is allegedly the "way it is supposed to be."
--The UK has a history of insisting on keeping minor patients against parents' and families' wishes when the intent is that the patient should die. This is the ultimate logical conclusion of the insistence that this is about what is medically appropriate rather than being (up front) about money. See, even if it costs us more money, we will keep your children and make sure that they die when we think that is what is supposed to happen according to our utilitarian calculus. This was the case in the David Glass case (though he was actually saved from the system by courageous relatives) and in the infamous Attard Siamese Twin case in 2000. The latter is especially noteworthy, as the parents, once they realized that the doctors wished to kill one of their children to save the other, simply wanted to be allowed to take their babies and go away in peace. Instead, the British system deliberately kept the twins, by court order, in order to carry out a costly surgery that killed one twin to save the other.
All of this brings me, finally, to the intentionally startling title of this post: In a number of ways it would be better if some patients were simply abandoned by the official medical system and discharged (without npo orders, needles to say) to their family or to nuns or other do-gooders (and I mean that phrase in an entirely non-pejorative sense), so that they could be taken care of as best as possible on a shoestring, rather than being kept as patients by the allegedly "civilized" medical system. This is because the "civilized" medical system will insist on bringing about their deaths by the deliberate, careful, and prolonged refusal of all food and water. This is especially true of patients that can eat, even small quantities, by mouth. To be sure, if all that an older or larger patient can eat and drink are small quantities, it will be impossible to keep him alive like this indefinitely. Sometimes a long-term PEG tube is inserted for this very reason, when a patient can indeed eat by mouth, but spoon feeding is so slow and inefficient that the patient will not be adequately hydrated and fed by this means over the long term. Nonetheless, at least the person will not simply dry up and die in ten days, and in the meanwhile the patient will be receiving the kindness of gentle attempted feeding which will also alleviate the discomfort of thirst.
Moreover, the medical system is heavily drugging these patients, sometimes to the point of sedating them, which makes them unable to eat by mouth. If they were discharged to be cared for as best as they could be in a low-tech fashion, this medicalizing of death need not occur, and there would be no presumption for heavy drugging or sedation. That would give them a better chance to eat and drink. Some might even survive much longer than expected by the all-wise doctors, or even recover, if only they received care rather than being deliberately killed by "nothing by mouth" orders plus major drugs. And those that did die could be treated more humanely in the meanwhile.
Having the medical establishment let go of the patients rather than keep them and kill them would also help to avoid the corruption of nurses, doctors, and family members by teaching them that it is okay to dehydrate people to death and by forcing them to steel themselves to go through this traumatic, lengthy, and gruesome process.
Finally, simply discharging the patients to the care of those who will take them would strip away the pretense of care that the medical system currently retains. By keeping control over the patient until he dies and carrying out medical acts like drugging the patient, the medical system retains a corpse-like caricature of professionalism: "See, we're not abandoning our patients. We're taking care of them." When, in fact, they're "caring for" them to death. By saying outright and more honestly, "We refuse to care for this patient anymore. You care for him, or find someone who will, as best you can. We disclaim all further responsibility," the medical practitioners of England, and the bureaucracy that controls them, takes off the mask. And by their doing so, the patient is given at least the possibility of living and being cared for better.
A possible rider to this suggestion would be that the hospitals agree, for patients expected to survive long-term if given basic care, to put a PEG tube in place and to teach family members to care for it and to use it to administer food and fluids. Since the patient will be "off their hands" after that, this relatively small final treatment could hardly be called an extravagance.
Lest I be misunderstood, I don't think that patients in the UK should have these as their only options--be dehydrated to death or be sent away--but if "caring" is going to mean killing by prolonged dehydration, being sent away instead to be cared for by someone else, even someone without medical credentials, begins to sound better and better. It at least ought to be offered as an explicit option.
Ideally, religious orders and groups could step forward, as Mother Teresa offered to "take" any child whom the mother wanted to abort: "If you don't want these patients, these disabled and elderly people, these newborn babies, we do. Let us care for them if you won't." Or the orders or religious charities could support families who wish to care for the person at home. All with the explicit promise, "We never dehydrate anyone to death. We are here to help you and your loved ones to avoid that fate."
Now, I hardly expect that this idea of mine will be seized upon eagerly either by the British or by anyone else. But if not, why not? Why, also, will a liberal such as the one described at the beginning of this post balk at such a suggestion? After all, he's the one suddenly getting all cost-conscious. He's the one getting smug and trying to play a gotcha game with the pro-lifer who also thinks socialized medicine a bad idea. Why oppose this idea?
What my proposal essentially says is this: If this medical system is so morally corrupt that it insists on killing its patients, then let my people go. Give them to those who will love them and care for them as best they can instead of killing them. Give others a chance, at virtually no cost to the "system." If you simply want our children, our elderly, our loved ones dead, then we aren't going to let you control their care anymore. Give the families an explicit option to take them elsewhere or take them home and feed them. And do that instead of arm-twisting the families to get them to agree to the deliberate, medicalized killing of the vulnerable. And if you won't, then shut the heck up about expense. Because it will be absolutely clear at that point that it's all a lie.
That is my case for "throwing patients out in the street." If that's the kind of hospital you're running, do the patients a favor: Throw them out.