Editorial Reviews. About the Author. The authors, Lee R. Kerr is a practicing Attorney and a Look inside this book. Natural death with dignity: protecting your right to refuse medical treatment by [Lee R.
Table of contents
Throughout the late s and s other states began passing similar laws. At the start of the twenty-first century, every state had laws protecting the rights of dying patients. There are several legal principles underlying these laws. The common law recognizes the right of each individual to control his own person without interference from others.
This right extends to the medical arena, requiring doctors to obtain the consent of their patients before treating them. As stated by U. Supreme Court Justice Benjamin Cardozo, "every human being of adult years and sound mind has a right to determine what shall be done with his own body; and a surgeon who performs an operation without his patient's consent commits an assault, for which he is liable" Schloendorff v. Society of New York Hospital, This consent must be informed, requiring doctors to disclose the nature of what they are doing and the risks and benefits.
The principle of informed consent to medical procedures governs all medical care, including life-sustaining treatment, and includes the right to refuse such treatment. Constitution also protects the right of dying patients to refuse medical care. It involved a twenty-one-year-old woman who had been placed on a respirator after she stopped breathing for unexplained reasons and then entered a chronic persistent vegetative state. The court granted her parents' request for removal of the respirator, finding that it infringed upon her right to privacy as protected under the Constitution.
Natural Death Acts
Fourteen years later, the U. Supreme Court, in the case of Cruzan v. Director, Missouri Department of Health, also involving a young woman in a coma, found that the Fourteenth Amendment to the Constitution, which provides that a person may not be deprived of her liberty without due process of law, includes a liberty interest in refusing heroic medical measures. These legal principles are embodied in Natural Death Acts, which outline the procedures for exercising the right of dying patients to refuse life supports.
Because many dying patients are incompetent at the time the crucial decision to withdraw or refuse life supports must be made, these laws provide mechanisms for patients to exercise their rights in advance. The primary mechanism is the advance directive, which is a statement, usually in writing, that declares what kind of lifesaving medical treatment a patient wants after he has become incompetent or unable to communicate to medical personnel.
One form of an advance directive, the living will, provides specific instructions on whether or not a person wants to accept life-sustaining medical interventions. Another form of advance directive is a health care proxy or power of attorney , which appoints another person to make the decision and which may also include instructions on life supports. The laws also set forth what is required to prove the wishes of the patient when he has failed to complete an advance directive. Many Natural Death Acts also provide for the appointment of a surrogate decision maker.
While each state has its own Natural Death Act, there is also a federal law, the Patient Self-Determination Act PSDA , which is designed to encourage patients to exercise their rights by completing advance directives. The PSDA requires hospitals, health maintenance organizations, and others that receive federal funds to tell patients of their rights under the applicable state law to make end-of-life medical decisions. The PSDA also requires that advance directives be maintained in patients' charts. Despite these laws, the vast majority of people—between 80 and 90 percent—never execute advance directives.
Nevertheless, largely through the passage of such laws, and the publicity generated by various right-to-die cases, a consensus has emerged over the years that patients have a right to refuse life-sustaining medical intervention. In one poll, 84 percent of Americans said they would not want life supports if they had no chance of recovery. How far that right should extend, however, is still a matter of controversy. Initial opposition to the "right to die" was based on a state's interest in protecting the sanctity of life, preventing suicide, and protecting innocent third parties i.
These interests, however, become less significant in cases where a patient is terminally ill or severely incapacitated with no hope of improving. The ethical integrity of the medical profession, whose primary mission is to enhance life, is also cited as a reason for opposing the right to die. Nevertheless, virtually every professional organization, including the American Medical Association, recognizes that patient autonomy and good medicine may require the withdrawal of life supports.
Natural Death Acts also typically include a "conscientious objection" exception that permits physicians with religious or moral objections to refuse to honor a request to withhold or withdraw life supports so long as alternative accommodations, such as transfer to another hospital, are made.
Natural Death Acts also do not distinguish between withholding and discontinuing life supports. Thus, for example, removing a ventilator from a patient is considered the same as never starting it.
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Courts have expressed some concern that PAD will lead to unseemly results for vulnerable populations, including the elderly and the disabled. It decreases the credibility of the suggestion that PAD entails physicians causing the death of their patients.
Encyclopedia of
With these statistics in mind, the concerns legal scholars had about PAD in no longer pose much cause for concern. Vulnerable populations did not disproportionately avail themselves of the ODWDA; rather, the exact opposite happened. The Supreme Court reasons that PAD cases are distinguishable from cases about refusing medical treatment because when patients refuse life-saving treatment, their disease kills them, but when a physician prescribes medication to assist patients in committing suicide, prescribed medication kills them.
This result is illustrative of a realization that the American justice system contemplates end-of-life issues in fundamentally the wrong way. When terminally ill patients seek a prescription of lethal medication, they are not merely receiving the assurance of a peaceful end of life.
Rather, these patients are being given something precious that they lost when they were first diagnosed with their terminal illness— their autonomy. But once in the medical system, we often lose the ability to help ourselves. Jerry Brown and was signed on October 5, The Supreme Court is not impervious to a simple shortage of available information. Everyday Americans are not the only ones confused about the legal issues surrounding end-of-life care.
For now, the Supreme Court has drawn a causation-based distinction between the refusal of medical treatment and PAD, which has the effect of allowing patients who rely on life-sustaining care to die, but barring terminally ill patients from doing the same, even when they are in great pain. However, statistical information about the utilization of PAD across different states might provide invaluable quantitative information about causation.
If Oregonians are not unique, and the rest of the country presents a similar pattern with regard to patient choices, the Supreme Court may have to revisit its distinction between PAD and refusal of medical treatment. In cases involving the removal of life-sustaining care, the Supreme Court has emphasized autonomy. The next time a PAD case reaches the Supreme Court, we should hope that there is enough quantitative evidence to show that the same emphasis on autonomy is due for the terminally ill. Currently, most states inadvertently send a grim message to their terminally ill residents: Candidate , University of Kentucky College of Law.
Noah, Politicizing the End of Life: Lessons from the Schiavo Controversy , 59 U. The latter of these situations is more difficult to identify and address when the patient in incompetent. For a discussion of the differences between scientific and ethical futility in the case of end-of-life case for Terry Schiavo, see id. The Supreme Court assumed without deciding that there was a constitutionally protected liberty interest in the refusal of medical treatment in cases involving competent patients.
Euthanasia - Illinois Right to Life
However, the Court did not decide that incompetent patients had a similar unqualified right. Because the wishes of incompetent patients cannot readily be determined absent some outside evidence, it is difficult to respect the autonomy of an incompetent patient.
The Belmont Report was developed in by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research to identify basic ethical principles that should guide the conduct of research involving human subjects. For example, some demonstration and service programs may include research activities. The Belmont Report is not blackletter law, but rather is a set of professional standards, originally intended only for research, but given broader application professionally.
Communication does not necessarily entail speaking. As long as the patients can communicate in some way, the law is satisfied. The bill was signed into law on May 20, , but many substantive portions of the law will not take effect until July 1, California has now also legalized PAD by legislative act. See infra Part III.
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- Mao Tse-tung und der Sino-Sowjetische Konflikt (German Edition).
Learn more about Amazon Prime. A Complete guide to living wills, durable power of attorney for medical consent, and other valuable information including forms gathered from around the nation, necessary to give you the education to limit or refuse medical consent. Full text of the Supreme Court landmark case, Cruzan, as well as the author's personal family struggles and tragic circumstances with refusing medical consent.
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