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Immigrant's death linked to inability to pay for medical care

March 11, 2011

A comatose immigrant woman died after she was discharged from Georgetown University Hospital and removed from her feeding tubes—against the wishes of her family—in a case that has raised concerns about the impact of finance on medical care.

Rachel Nyirahabiyambere was admitted to Georgetown University Hospital, an institution “in the Jesuit tradition,” after she suffered a debilitating stroke in April 2010. When she remained comatose and unresponsive, and family members failed to arrange for her transfer to a hospice facility, the hospital petitioned for a court-appointed guardian to arrange for her future. That guardian, whose appointment the woman’s family members opposed, arranged to have Nyirahabiyambere moved to a nursing home, where her feeding tube was removed, leading inevitably to her death.

The case is complicated by the family’s inability to reach a decision on the woman’s medical care. But the woman’s inability to pay for care—because she did not carry health insurance, and as a recent immigrant was not eligible for Medicaid—was clearly a factor in the handling of her case.

A New York Times report on the case quotes bioethicist Arthur Caplan: “Any hint that withdrawing treatment might be linked to financial considerations—that’s a big ethical no-no. That’s death panel stuff.”

Moreover, providing nutrition through a feeding tube is not normally classified as “treatment,” but as fundamental “care” for a patient. The Vatican has indicated that the removal of nutrition and hydration, in order to hasten the advent of death, is never morally acceptable.


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Show 3 Comments? (Hidden)Hide Comments
  • Posted by: - Mar. 13, 2011 12:32 PM ET USA

    Actually, Canada is as driven by monetary concerns as the US. There are many cases of parents/relatives wanted to prolong life and the GOVERNMENT insisting on discontinuing "treatment" (ie, feeding tubes, ventilators, etc). But in this case, it was the NURSING HOME that removed the tube so why is the Catholic hospital grabbing the headline? And how is this case any different from Terry Schiavo's?!?

  • Posted by: - Mar. 12, 2011 7:37 AM ET USA

    Mike: I think even the hint of somebody being denied medical care on financial grounds is what Arthur Caplan means by 'death panel stuff''- “Any hint that withdrawing treatment might be linked to financial considerations—that’s a big ethical no-no. That’s death panel stuff.”

  • Posted by: Mike in Toronto - Mar. 11, 2011 7:37 PM ET USA

    What "death panel stuff"? In Toronto, Canada, she'd still be alive. Why? Universal health care. No, not communism: "universal health care".