‘An affront to human dignity’: Ethicists react to death of Michael Hickson

Washington, D.C. Newsroom, Jul 1, 2020 / 15:00 pm

Ethicists and disability rights activists have expressed grave concerns over reports of the recent death of Michael Hickson, a black man with quadriplegia and a brain injury who was denied medical treatment due to his disabilities. 

Hickson, 46, died on June 11, six days after a doctor at St. David's South Austin Medical Center told Hickson's wife, Melissa, that he did not think that Michael had a quality of life due to his disabilities and would therefore not receive medical treatment, he was subsequently transferred to hospice care. Melissa recorded the conversation, and the video was posted on YouTube. 

Michael was admitted to the medical center after he contracted COVID-19 and pneumonia at the nursing home where he lived. 

Dr. John Di Camillo, and ethicist at the National Catholic Bioethics Center told CNA that denying care based solely on a disability or presumptions about a patient's quality of life is an "affront to the dignity of the human person and a tragedy of medical ethics."

"A patient or surrogate decision-maker has the moral option to decline treatments that are extraordinarily burdensome or minimally beneficial," Di Camillo said, "and clinicians have the duty to convey facts, expectations, and recommendations, but a refusal of care based on quality of life alone simply should not happen." 

Dr. Harold Braswell, an bioethicist at St. Louis University, told CNA that while he cannot be sure what the doctor in the video was thinking, "given the objections of the family [...] and a general tendency among health care professionals to underestimate quality of life among disabled people, it's grounds for concern." 

"Disability rights advocates have almost universally opposed 'quality of life' as a criteria for making triage decisions during COVID-19," said Braswell, and that the preferred metric for triage is "survivability." "Survivability" refers to the chance that a person will survive the medical interventions. 

"But survivability doesn't seem to be an issue in this case--hence Mrs. Hickson's surprise that her husband was being put on 'hospice,'" said Braswell. He called the citation of "quality of life" a "big red flag." 

At least one disability activist views Mr. Hickson's death as a homicide. 

"The murder of Michael Hickson by a hospital system that doesn't care is a tragic example of how our priorities have shifted," Steven Spohn, a public speaker and disability activist, told CNA. 

"We used to be a nation that cared about Christian values and taking care of one another. Now people who need our support go unheard," he said. 

Spohn told CNA that he believes there are "thousands of cases just like Michael's" who do not receive media attention. 

"I wish that the media would pay attention to the injustice being done to people with disabilities on many fronts," he said. 

Dr. Charles Camosy, a professor of bioethics at Fordham University, also told CNA that he was confused by the relative lack of major media attention given to Hickson's death, especially in light of the increased attention to racial justice. 

"Given what we know about how rightly distrustful African Americans are of contemporary U.S. medicine, especially at the end of life, it is absolutely shocking that this clear issue of racial justice and medicalized violence is not being picked up broadly by major media outlets," Camosy said first on Twitter and then to CNA. 

Since the death of George Floyd, a black man who died on May 25 in the custody of the Minneapolis Police, there have been a series of protests and increased attention given to the mistreatment of ethnic minorities in American society, something Camosy said is "helpfully exposing examples of both personal and structural racism." 

"And yet, at least for now, all we hear are crickets [regarding Hickson's death] except in the pro-life and disabilitiy communities," said Camosy. 

Camosy acknowledged that while there may be times that require medical rationing, "there is no evidence that this was the case, and the doctor made it clear on the recording that he was aiming at his patient's death on the basis of his disability." 

In the video, when Melissa asked to clarify that the doctor was referring to Michael's disabilities when he claimed that her husband "didn't have much" of a quality of life, the doctor replied "correct."

In the recorded video, the doctor explained to Melissa that the patients who were treated successfully with the drug he was refusing to administer to Michael were "walking and talking," unlike her husband. 

In a second video Melissa posted to YouTube, she describes how she was not informed of her husband's death for over 12 hours, and states that she was not allowed to visit him in hospice or have a FaceTime call with him before his death. She called for people to contact her husband's doctors and medical guardians, who she says failed him in his final days. 

"Michael's widow is pleading for us to hold the people who did this to account, and that we must do," said Camosy. "Because black lives matter."