Today, in Slate, Steven E. Landsburg recounts the sad story of 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.

    Landsburg goes on to argue, pace some other bloggers, especially YucatanMan at DailyKos, that this was a reasonable decision.  YucatanMan is outraged because this appears, on its face, as a clear case of class discrimination – a person of means would have been able to pay the bill and live, while the poor person could not pay and dies.  Landsburg counters that, if she had been given the choice beforehand (which she wasn’t!), Ms. Habtegiris would not have taken out "ventilator insurance" (does such really exist?), but would have chosen some other other distribution of resources that would have suited her immediate consumer preferences.   In other words, Ms. Habtegiris may not have chosen to expend the resources to keep herself alive under such circumstances; therefore, Landsburg argues, we should not fault the hospital for cutting off life support.

     The more I think about Landsburg’s position, the more wrong I think it is. So, what criteria should be used to deal with such issues?

    As I have argued elsewhere, Confucian and Taoist perspectives broaden our range of considerations in such cases.  I will develop the Confucian line of thought here (only because it is more distinct than the position taken by Landsburg).  The Taoist position would likely lean against extraordinary life-support, not for economic but naturalistic reasons.  But what would Confucians say?

   Landsburg is too individualistically liberal.   The thought experiment offered by Landsburg – it is not based on any real information about Ms. Habtegiris’s actual preferences, but is just a economistic "what if" projection – presumes that the decision to end life support should be wholly a matter of the individual preferences of the person involved.  Just like purchasing any other commodity. 

    A Confucian-inspired response would point out that a life is not, and never should be considered, just another commodity.  A life has social implications and responsibilities above and beyond individual preference.  A life is enmeshed with a series of other lives – families and friends and colleagues – that stand to lose something if the life is lost.  Therefore, a modern Confucian would suggest that these other people must be a part of any decision to withhold life support.  That is not to say that these others would have an absolute veto over an individual’s preferences should there be disagreement, but there needs to be some consideration.

     On these grounds, the hospital clearly erred.  Close family members were pleading with the hospital to keep Ms. Habtegiris alive long enough to make arrangements for her mother to travel from Africa to Texas to see her daughter for a last time.  Indeed, Ms. Habtegiris’s condition was grave – she had advanced cancer that necessitated a respirator; she was likely going to die soon in any event.  Why could not some more time be taken out of respect for the wishes of the family?  Why not a little more time until her condition declined to the point where she was no longer conscious as least (she was apparently conscious when they pulled the plug!) and unable to interact fully with her loved ones?

    In these circumstances, cold calculations of profit overruled humane standards.  Landsburg is wrong to try to salvage the economic rationale in this case.

Update: Mark Kleinman has a liberal critique of Landsburg.