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January 10, 2006 | Read comments | Post a comment

Using Tirhas Habtegiris

Last Tuesday, Slate posted "Do the Poor Deserve Life Support? A woman who couldn't pay her bills is unplugged from her ventilator and dies. Is this wrong?" By Steven E. Landsburg. Economics prof Landsburg, who writes a regular economics column for Slate, has published several popular books on economics.

Tirhas Habtegiris, a 27-year-old terminal cancer patient at Baylor Regional Medical Center in Plano, Texas, was removed from her ventilator last month because she couldn't pay her medical bills. The hospital gave Ms. Habtegiris' family 10 days' notice, and then, with the bills still unpaid, withdrew her life support on the 11th day. It took Ms. Habtegiris about 15 minutes to die. (Read article.)

Note that this unplugging happened last month. Mid-December.

The blog entry on Daily Kos where Landsburg learned about Habtegiris was posted by "YucatanMan" on Dec. 14.

Until the Slate entry (sent to me by a reader), I'd heard nothing about this death. Nothing from any of the disability groups who keep up with this sort of thing. I've been away from Kos myself; although I've posted entries there, I haven't done so for several weeks.

My first thought: how can such a story have slipped by so many of us -- maybe all of us who write about disability rights? My second thought: did the story of Tirhas Habtegiris's death get any media attention beyond blogs in cyberspace? It couldn't have gotten too much, I figured, or we'd have heard of it.

Which always brings up for me the next thought: about how information comes and goes, and spreads, or is buried, or never comes out at all. But that's for another blog.

Turns out YucatanMan got his information from a TV news story on the Dallas-Forth Worth CBS affiliate. A search of Google News strongly suggests that even in Dallas the story wasn't that big. Dallas-area daily newspapers didn't cover it -- the search turned up 4 news items.

So we have here a death by turning-off-of-ventilator. And we have the political uses of that death.

The first thing that could be said about deaths like Habtegiris's is that they are not uncommon. The second thing that can be said is that they go mostly unreported in the media. They are the result of futile care policies which people like Wesley Smith and Not Dead Yet have been trying to tell us about for years.

Futile care policies are increasingly common in hospitals. Like virtually everything else, they are interpreted as good things by some people and bad things by others.

People who believe that healthcare rationing is sensible and crucial in our economy applaud futile care policies, saying that for people who are not going to recover and who have no quality of life, they make sense. People called "life advocates" ("right to lifers") see them as weapons for institutionalized murder. But in this case, it was folks at the other end of the ideological spectrum yelling "murder!"

Habtegiris's Leftie bloggers see racism and classism at the root of Baylor's decision to turn off the woman's respirator. They call the futile care policy that occasioned Habtegiris's death institutional murder as well.

Strange bedfellows, eh?

When you scratch just a little bit beneath the surface of almost any contentious social issue, more of than not you find strange bedfellows. It happens so often that if we weren't so keen on loving our categories, we might start to think that our "strange bedfellows" concept itself is flawed.

Perhaps what is strange is that we believe there are clear distinctions in our society: left/right, conservative/progressive, Republican/Democrat. And then when we find folks crossing those lines on issues, we say they make "strange bedfellows." Maybe what's actually strange is our conventional belief that people stick to one ideology down the line.

The other interesting thing is how quickly an individual's death turns into propaganda for whatever horse is being ridden at the moment.

Thus we have Slate's Landsburg and Kos's YucatanMan using the same woman for two arguments that seem opposed.

But below the top layer of duff, they seem more pointless than anything else.

From a Kos commenter:

The culture of life fights right to die legislation every chance it gets.  

If this woman had asked to have her respirator removed they probably would have arrested her doctor for assisting suicide.

Landsburg says the Daily Kossacks are "appalled because 'economic considerations,' as opposed to what the bloggers call "compassion," drove the decision to unplug Ms. Habtegiris." Here's what YucatanMan wrote on DailyKos:

No one here can forget the spectacle made over the death of Terri Schiavo, whose brain had died long, long ago.  But in Texas, the law George W. Bush signed as governor allows doctors to inform the family that further treatment is hopeless (and costly) and Pull the Plug.  Literally.

In the latest case to escape the Culture of Life warriors, Tirhas Habtegiris, a young woman and legal immigrant from Africa, was CONSCIOUS and responsive when removed from a respirator and allowed to die.
Let me rephrase that:  She was killed by doctors who removed the ventilator keeping her alive. And this action was fully legal .... Her body was ravaged by cancer, but she was alert. She was responsive. (Read entire blog entry.)

Landsburg thinks the Kossacks simply don't understand economics:

A policy of helping everyone who needs a ventilator is a policy of spending less to help the same class of people in other ways.

The dead Tirhas Habtegiris began to find a ghostly half-life in cyberspace, mostly on leftie blogs: from the Left Coaster 's blog entry:

When I first read this story, I was incredibly outraged. After all the weepy crap we heard from the so-called pro-lifers over Terri Schiavo, it becomes clear that these 'religious' types are pure hypocrisy on two feet - they are only interested in maintaining WHITE life.

Tirhas Habtegiris is clearly not white.

Where were all of your Good Christians who interrupted your lives to go protest in Florida on Terry Schiavo's behalf? Why weren't you in the streets of Plano, Texas demanding that Baylor Regional Medical Center keep this woman alive?

From Jeff on Babble:

"Tirhas Habtegiris, a 27-year-old terminal cancer patient at Baylor Regional Medical Center in Plano, Texas, was removed from her ventilator last month because she couldn't pay her medical bills. The hospital gave Ms. Habtegiris' family 10 days' notice, and then, with the bills still unpaid, withdrew her life support on the 11th day. It took Ms. Habtegiris about 15 minutes to die."

PS. She was black.

I am trying to get my mind around not only what happened to Habtegiris, but what these blog posts and comments -- mostly by people who support legalizing physician-assisted suicide -- reveal about the larger issue out here in society where people like Habtegiris are dying as a result of futile care policies every day, where their deaths are going unreported in the media, and where the movement for the right to die will heat up again as soon as the Supremes rule on the Gonzales v. Oregon case.

What I get from the Kos commenters, overall, is this sentiment: Habtegiris was murdered because she was poor and black. (A number seem surprised to learn, from fellow commenters, of the existence of "futile care policies" altogether. Not surprisingly, they don't like what they learn. ) Many seem to believe it significant that she was removed from her respirator in George Bush's state. The commenters note that Habtegiris wanted to live just a little bit longer, and wasn't allowed to.

I despise what George W. Bush and Co. are doing to this country, and make no bones about it. But much of the posturing about Habtegiris seems to me to be more than anything else a chance to yell about Republicans in general and right to lifers in specific -- and not much of anything else.

Is it too much to ask that our progressives go a bit deeper in their analyses?

Posted by mjohnson on January 10, 2006 03:38 PM


For now, I'll simply post this link.

This is another young gal who had cancer. See this scenerio at the link below. In both cases, the client/patient, nor their families had any say.

Both cases were in Texas.

What is the difference between these two stories?
What is the same about these two stories?

Is there a difference? Or is there a bigger picture we have not, as of yet, taken a look?

Feedback would be great to hear.


Posted by: Denise on January 11, 2006 05:39 AM

Posted by: Denise on January 11, 2006 07:05 AM

First of all I would like to note that I find it astonishing that in the limited coverage of the Habtegiris-case, nobody seems to care what the wishes of the patient were, focussing exclusively on the doctors' and the family's requests. As far as I'm concerned the ground rule in all end-of-life decisions is that you do not hasten someone's death if that person opposes it. I assume the concerning Texas law was meant to be used in cases where the patient was inable to express his/her will, which in this case does not seem to apply.

In the Wernecke-case the patient was a minor and thus not legally capable of making an informed decision about her treatment options (especially so in this case since she would certainly have been under a lot of pressure to adopt her father's view). In this situation treatment should be based on the best interest of the child. As I understand it, Katie originally had a 90% chance of recovery accepting the radiation, which would drop to 50% if she did not receive it, regardless of receiving vitamine C-treatment. This is really not a very hard choice to make.
Sometimes people believe what they want to believe and I suspect that's what happened when the Wernecke's decided to believe that their daughter could survive without the additional burdens of radiation, but as MD Anderson's doctors are not being trained in wishful thinking but in objective medicine, I support their position in this matter. It is very unfortunate that Katie had to fight this battle living in foster care, but in cases like this you only get to make a choice once and if that choice is between a 50% chance of survival or a 90% chance of survival I think she deserved the 90%. If she had gotten the right treatment from the start, she may have been away from her parents for a few months, but they would still have her for years to come.

I feel that in any decision to cease treatment the patient should be the prime decision maker and if that person is not competent to make a decision the best interest of the patient should prevail. This does not mean that doctors are always right or that families are always right, nor that 'pulling the plug' is a leftist or rightist issue, it's an issue of doing what is right.

Posted by: heidi on February 9, 2006 05:43 AM

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