March 4, 2011 | Posted By Bruce D. White, DO, JD


At first glance, one might wonder if the article in today’s New York Times by Deborah Sontag—“Immigrant’s Health Crisis Leaves Her Family on Sideline”—is signaling a paradigm shift in health care delivery that may be just as dramatic and earth-shattering as the Karen Ann Quinlan, Nancy Beth Cruzan, Terri Schiavo, or Sun Hudson cases. Click the picture below to be taken to the article.

(photo from

The patient—a 58-year-old legal immigrant from Rwanda in a persistent vegetative state after a devastating stroke eight months ago—lies in Georgetown University Medical Center maintained by a surgically placed feeding tube. Because of her immigration status she is not eligible for Medicaid.

On February 19, her court-appointed guardian agreed to the removal of the artificial feedings and the institution of a palliative care plan over the objections of her six adult children (two of whom are United States citizens).

There are so many issues that the newspaper report identifies directly and indirectly, most of which turn on notions of justice, equity, and fairness. These are issues that ethics committees and individual clinical ethics consultants haven’t dealt with very often in the usual and customary hospital ethics dilemmas that more often typically involve beneficence, maleficence, and autonomy.

As a learning and teaching exercise, it might be very helpful just to list the ethics issues raised in this case and assess how prepared we all are to deal with them?


2 comments | Topics: Bioethics in the Media , End of Life Care , Health Insurance , Patient Autonomy


sheila otto

sheila otto wrote on 03/04/11 3:10 PM

I cannot imagine supporting this withdrawal without the family onboard, in part, because of the fear of liability and in part because it is so contrary to our standard of doing whatever the family wants. Having said that, there are larger justice issues looming and the harsh reality is that without a payer source, nursing home maintenance care is not going to happen and the hospital setting is totally unnecessary and inappropriate. Being an African without insurance....not a great poster child for this policy issue of withdrawal against a family's wishes.
sheila otto

sheila otto wrote on 03/30/11 1:25 PM

decision reversed on appeal

Add A Comment
(it will not be displayed)

BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.