Early in July, a judge in Minnesota...


Early in July, a judge in Minnesota ruled against physicians at Hennepin County Medical Center who asked permission to disconnect a respirator from an 86-year-old woman against her husband's wishes.

The woman, Helga Wanglie, was covered by private medical insurance, so getting the bills paid was not the hospital's concern. What worried the doctors and prompted their action was simply the futility of the treatment they were giving her against their better judgment.

Mrs. Wanglie was in a persistent vegetative state, a condition in which the care she was receiving could mechanically keep her heart beating and lungs breathing but could not restore her to consciousness. In similar situations, many families have sought court permission to allow their loved one to die. In this case, the patient's husband was adamant that she be kept breathing at any cost and by every heroic means possible. As it turned out, she died shortly after the ruling was issued.

Despite the physicians' objections to providing what they considered inappropriate treatment, the judge ruled that these decisions should rest with family members. As legal precedents go, that is a better one than a ruling handing over these decisions to medical authorities. Even so, the questions this case raises are still with us.

A right to make decisions carries with it an obligation to make responsible choices -- choices that are, to the best of our ability, informed, compassionate and ethical. But let's face it, many of us are overwhelmed or intimidated by modern medical technology and, all too often, we don't get enough help from physicians or other professionals in thinking through these issues.

Given the value our society and our religious traditions place on life, making a decision to withhold or withdraw life support is never easy.

But as we read about difficult cases like Mrs. Wanglie's, it's impossible to ignore the bigger picture. In discussions about health care choices there is a nagging question that won't go away: How can this country justify spending millions of dollars keeping alive patients who are fortunate enough to have medical coverage, while millions of Americans die preventable deaths -- simply because they never had the care that would keep them in good health?

As medical science learns more about persistent vegetative states, it has become possible to say with a fair measure of confidence that, beyond a certain point, medical care is simply prolonging the dying process.

No one knows exactly how many people in the country are being kept alive in such a condition, but some estimates are as high as 20,000. The cost of their care is enormous, probably exceeding $100,000 a year per person. Like Mrs. Wanglie, some of them are covered by private insurance, but in many cases the cost is borne by the taxpayers. The state of Missouri spent more than $1 million to keep Nancy Cruzan alive, against the wishes of her family.

In a recent essay on health care costs, Joan H. Lewis of the District of Columbia Hospital Association raised some provocative questions:

* Does government have the right to spend limited health care dollars to keep people alive?

* What about the millions of Americans who are not poor enough to qualify for Medicaid but cannot get access to insurance that would pay for basic medical care? Do they have grounds for a class-action lawsuit?

* And even when the money is coming from private insurance, not from the public till, is it fair for other policy holders to carry the brunt of futile treatment?

These are not easy questions. But increasingly health care administrators like Lewis are raising them. It's time they got attention.

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