Can healthcare providers obtain judicial intervention against surrogates who demand "medically inappropriate" life support for incompetent patients?

Critical Care Medicine

Volumn 24, Issue 5, 1996, Pages 883-887

  Cantor, Norman L ^a,b  

^a Lewis and Clark Law School   (United States)

^b c/o SI Newhouse Center for Law and Justice ^*  (United States)

Author keywords

Bioethics; Decision making; Ethics committees; Euthanasia, passive; Legal guardians; Life support care; Medical futility; Physician patient relations; Quality of life; Terminal care

Indexed keywords

AUTHORITY; COURT; DOCTOR PATIENT RELATION; DYING; EUTHANASIA; HEALTH CARE PERSONNEL; HUMAN; LAW SUIT; LEGAL ASPECT; MEDICAL DECISION MAKING; MEDICAL ETHICS; PRIORITY JOURNAL; RESOURCE ALLOCATION; REVIEW; TERMINAL CARE; TREATMENT OUTCOME; UNCONSCIOUSNESS;

CLINICAL APPROACH/SOURCE; COMPETENCE; DEATH AND EUTHANASIA; DISSENT; FAMILY MEMBERS; FUTILITY; IN RE BABY K; IN RE JANE DOE; IN RE WANGLIE; JUDICIAL ACTION; LEGAL APPROACH; RESOURCE ALLOCATION; SUFFERING; UNITED STATES;

COMA; DECISION MAKING; DISSENT AND DISPUTES; ETHICS, MEDICAL; FAMILY; GROUP PROCESSES; HEALTH CARE RATIONING; HUMANS; JUDICIAL ROLE; LEGAL GUARDIANS; LIFE SUPPORT CARE; MEDICAL FUTILITY; MENTAL COMPETENCY; PATIENT ADVOCACY; RESOURCE ALLOCATION; STRESS, PSYCHOLOGICAL; UNITED STATES; VALUE OF LIFE; WITHHOLDING TREATMENT;

EID: 0030006571     PISSN: 00903493     EISSN: None     Source Type: Journal    
DOI: 10.1097/00003246-199605000-00026     Document Type: Article

References (40)

1. Matter of Baby K, 832 F. Supp. 1022 (E.D. Va. (1993), aff'd 16 F.3d 590 (4th Cir. 1994). See also Paris JJ, Crone RK, Reardon F: Physicians' refusal of requested treatment, the case of Baby L. N Engl J Med 1990; 322:1012-1015 (involving a dispute between physicians and a parent over treatment of a 2-yr-old girl, blind, deaf, and quadriplegic);
2. Capron AM: Baby Ryan and virtual futility. Hastings Cent Rep 1995; 25:20-21 (involving a premature infant suffering from multiple deficits);
3. Weiser B: A question of letting go; child's trauma drives doctors to reexamine ethical role. Washington Post July 14, 1991, p A-1 (involving a dispute about treatment of an 18-month-old child dying of acquired immunodeficiency syndrome)
4. In re Jane Doe, 418 S.E.2d 3 (Ga. 1992)
5. In re Helen Wanglie, # PX-91-283 (Minn. Dist. Ct., Probate Div., 1991). See also Koch KA, Meyers BW, Sandroni S: Analysis of power in medical decision making: An argument for physician autonomy. Law Med Health Care 1992; 20:320-326
6. In one Florida case, a lower court judge refused to allow a hospital to detach a respirator from a patient dead by brain-death criteria; the patient's family would not accept the medical declaration of death. (Parents will get custody of brain-dead girl. Chicago Tribune February 19, 1994, p 2). However, no judicial opinion was published and the case cannot be considered an important legal precedent.
7. Greenhouse L: Hospital appeals ruling on treating baby born with most of brain gone. NY Times September 24, 1993, p A10 (quoting Professor John Paris with reference to the Baby K case)
8. Koch et al., NY Times op. cit.;
9. Jecker N: Knowing when to stop: The limits of medicine. Hastings Cent Rep 1991; 21:5-7
10. Veatch RM, Spicer CM: Medically futile care: The role of the physician in setting limits. Am J Law Med 1992; 18:15-36;
11. Lantos JD, Singer PA, Walker RM, et al: The illusion of futility in clinical practice. Am J Med 1989; 87:81-34;
12. Truog RD, Brett AS: Sounding Board: The problem with futility. N Engl J Med 1992; 326:1560-1564
13. Even if a physician believes a particular treatment would be physiologically useless, though, the incompetent patient's representative might still deserve a chance to seek a second opinion or secure another healthcare provider. See New York State Task Force on Life and the Law: When Others Must Choose. New York, New York State Task Force on Life and the Law, 1992, p 201
14. Beauchamp T, Childress J: Principles of Biomedical Ethics. Fourth Edition. New York, Oxford University Press, 1994, pp 212-213, 218;
15. Morreim EH: Profoundly diminished life. Hastings Cent Rep 1994; 24:33-41
16. Cranford R, Gostin L: Futility: A concept in search of a definition. Law Med Health Care 1992; 20:307-309
17. New York State Task Force on Life and the Law, Law Med Health Care op. cit., p 200
18. Beauchamp T, Childress J, Law Med Health Care op. cit., pp 210-214
19. Baby K, supra, 832 F. Supp. at 1031; Jane Doe, supra, 418 S.E.2d at 6-7
20. Guardianship of L.W., 482 N.W.2d 60 (Wis. 1992);
21. Guardianship of Doe, 583 N.E.2d 1263 (Mass. 1992). Although Cruzan v. Director, Missouri Dep't of Health, 497 U.S. 261 (1990) upheld Missouri's insistence on prior, competent expressions as a predicate for surrogate removal of life support, Cruzan does not undermine the numerous decisions in other states allowing removal of life support from a permanently unconscious patient. Cruzan cites many of those decisions. Id. at 276-277
22. See cases cited in reference 14, supra, and Matter of Warren, 858 S.W.2d 263 (Mo. App. 1993);
23. Cantor N: The permanently unconscious patient, non-feeding, and euthanasia. Am J Law Med 1989; 15:381-138
24. The judicial result might well be different where it is shown that the now-unconscious patient had, while previously competent, issued instructions rejecting life support in the circumstances now at hand. See generally Cantor N: Advance Directives and the Pursuit of Death with Dignity. Bloomington, Indiana University Press, 1993
25. Brody B: Special ethical issues in the management of PVS patients. Law Med Health Care 1992; 20:104-115
26. In re Jobes, 529 A.2d 434 (N.J. 1987); In re Estate of Greenspan, 558 N.E.2d 1194 (Ill. 1990)
27. Brody B, Law Med Health Care op. cit.;
28. Morreim EH, Law Med Health Care op. cit.
29. Angell M: After Quinlan: The dilemma of the persistent vegetative state. N Engl J Med 1994; 330:1524-1525;
30. Schrode KE: Life in limbo: Revising policies for permanently unconscious patients. Houston Law Rev 1995; 31: 1609-1653
31. Kolata G: Court ruling limits rights of patients. NY Times April 22, 1995, p A6
32. Clayton EW: Commentary: What is really at stake in Baby K? J Law Med Ethics 1995; 23:13-14
33. Peters PG, Ely JW, Zweig SC, et al: Physician willingness to withhold tube feeding after Cruzan: An empirical study. Missouri Law Rev 1992; 57: 831-857
34. Daar JF: A clash at the bedside: Patient autonomy vs. a physician's professional conscience. Hastings Law J 1993; 44:1241-1297
35. Beauchamp T, Childress J, Hastings Law J op. cit., p 246;
36. Cantor N, Hastings Law J op. cit. reference 16, pp 87-92
37. Daar JF, Hastings Law J op. cit., p 1273
38. Miles SH: Medical futility. Law Med Health Care 1992; 20:310-315
39. Alpers A, Lo B: Futility: Not just a medical issue. Law Med Health Care 1992; 20:327-329;
40. Cranford R, Gostin L, Law Med Health Care op. cit., pp 308-309