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Right to refuse life-sustaining medical treatment. Quinlan case. Right to privacy, rational choice, autonomy, informed consent.... More...
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Paper Abstract:
Right to refuse life-sustaining medical treatment. Quinlan case. Right to privacy, rational choice, autonomy, informed consent.

Paper Introduction:
Right to Refuse Life-Sustaining Medical Treatment In 1976, the New Jersey Supreme Court rules that comatose Karen Ann Quinlan's constitutional right to privacy protected her right to refuse medical treatment and allowed her physicians to disconnect the respirator keeping her alive. Since In Re Quinlan courts nationwide have confronted the issue whether to allow withdrawal of life-sustaining medical treatment, and over fifty cases have resulted in similar verdicts. However, a growing number of these decisions use the common law doctrine of "informed consent" rather than the constitutional "right to privacy" as the foundation for the evolving right to die. A patient's exercise of the right to die is a form of euthanasia, which Black's Law Dictionary defines as "the act or

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It is recognized that the traditional family relationship is "as oldas and fundamental as our entire civilization."[13] Courts have viewed theproblem as a balancing between the rights of the incompetent and theinterest of the state. Conversely,the right to informed consent implies a right to informed refusal. If the right toprivacy had as its foundation the right to bodily integrity, then thatright outweighs the state's interest in preserving medical integrity. Each of us wishes to be accorded respect and to be allowed tofunction autonomously-to engage in personal freedom of action.[7] Althoughautonomy, in and of itself, is not a legally protectible interest, in thehealth care setting autonomy is viewed as the patient's right to make hisown decisions. 394, 432, 529 A.2d 434, 453-54 (1987). Meyers, Medico-Legal Implications of Death andDying 352-53 (1981). 337 (1979).Black's Law Dictionary (5th ed. Courts upholding a rightto die usually characterize it as a right to refuse life-sustaining medicaltreatment. Right to Refuse Life-Sustaining Medical Treatment In 1976, the New Jersey Supreme Court rules that comatose Karen AnnQuinlan's constitutional right to privacy protected her right to refusemedical treatment and allowed her physicians to disconnect the respiratorkeeping her alive.[1] Since In Re Quinlan courts nationwide have confrontedthe issue whether to allow withdrawal of life-sustaining medical treatment,and over fifty cases have resulted in similar verdicts. "Medical Paternalism or Legal Imperialism: Not the Only Alternatives for Handling Saikewcz-type Cases," American Journal of Law & Medicine 5, (1979): 97.In Re Caulk, 125 N.H. [8]A living will is an advanced written directive instructingphysicians to withhold or withdraw life-sustaining procedures in the eventof a terminal condition. BibliographyAbraham. 479, 496 (1965).----------------------- 1 The U.S. Concluding that Quinlan's right toterminate her existence should not be discarded solely because her comatosecondition prevented her from doing so herself, therefore, the courtdetermined that Quinlan's right to privacy could be asserted on her behalfby her father.[6] In Superintendent of Belchertown State School v.Saikewicz, the Supreme Judicial Court of Massachusetts identified thegenerally accepted state interests which must be weighed against apatient's right to refuse life-sustaining medical treatment. [6]Id. Typically, aparent, spouse or other relative petitions a court to be appointed apatient's guardian for the purpose of discontinuing life-sustaining medicaltreatment. Abraham, "Ethicists Try to DefineStatus of Vegetative Patients: Dead? Connecticut, 381 U.S. Even though a patient is incompetent, evidence of his desireregarding medical treatment may be documented in a living will.[8] Notwithstanding criticism and dispute over the role of paternalism inmedical care, the doctor is still the most appropriate decision maker insome circumstances.[9] The doctor is in the best position to make adecision when there is no family, or when the patient has left no priordirective and the family prefers that the physician decide. & Med. Harmon, 76 S.W.2d 4 8, 416 n.11 (Mo. J. In thereal of medicine and scientific advancement, the ability of the law to keepabreast is limited by the slower pace of legal decision making and change. The debate surrounding the right to refuse life-sustaining medicaltreatment is a product of the medical profession's increasing technicalability to sustain life where it previously could not do so. 3 4 (1989). The Quinlan court acknowledged the state's dual interests inpreserving life and defending the medical profession's right toadministrator treatment as it saw fit. Ethicists also distinguish betweenvoluntary and involuntary forms of euthanasia. 1952). To determine whether the right to privacy encompasses the right torefuse life-sustaining medical treatment necessarily requires a definitionof the right to privacy itself. Medico-Legal Implications of Death and Dying, 352-53 (1981).Mill, J.S. The term "right to die"generally refers to passive voluntary euthanasia. 394, (1987).Kamen, "When Exactly Does Life End." Washington Post, 18 September 1989, 31.Meyers, D. It is not easy for physicians and nurses to terminatetreatment. [3]For a general discussion of the right to privacy, see L. Confronted withdramatically new and difficult fact situations, the courts understandablyrely on analogous doctrines-guardianship, substituted judgment, battery,informed consent-when formulating opinions around the new situation. Ct. A patient's exercise of the right to die is a form of euthanasia,which Black's Law Dictionary defines as "the act or practice of painlesslyputting to death persons suffering from incurable and distressing diseaseas an act of mercy."[2] Ethicists distinguish between active euthanasia,the active administration of a death-producing agent to accelerate death,and passive euthanasia, sometimes referred to as antidysthanasia, thewithholding or termination of life-sustaining medical treatment to allow adisease to run its natural course. 1. Arthur and W.H. 337 (1979); Buchanan, Medical Paternalism or LegalImperialism: Not the Only Alternatives for Handling Saikewcz-type Cases, 5Am.J.L. Connecticut.[4] The Court's demonstrated reluctance to discovernew privacy rights outside the context of marriage, family, and procreationsuggests that the constitutional right to privacy does not protect a rightto refuse life-sustaining medical treatment. New England SinaiHospital, Inc., 398 Mass. The American Medical Association (AMA) estimates that 1 , Americans fall into irreversible comas each year and that approximately 7 %of all Americans will face a decision to refuse life-sustaining treatmentfor themselves or a family member at some point in their lives.[5] Thepatient's family and health-care provider will agree that there is nothingmore that can be done for the patient; the health-care provider willdisconnect the patient's respirator, remove the patient's feeding tube, orotherwise discontinue life-sustaining medical treatment, and the patientwill die a normal death. In fact,cases recognizing a privacy-based "right to die" usually recognize thepatient's right to refuse life-sustaining medical treatment. 1979), 497. 479 (1965).In Re Jobes, 1 8 N.J. Unfortunately, no simple definition of theconstitutional right to privacy exists.[3] The right to privacy does notappear in the text of the constitution itself. "Medical Paternalism and the Rule of Law: A Reply to Dr. Relman," 4 American Journal of Law & Medicine. Rather, it appears anddisappears in the penumbrae and emanations of specific guarantees in thebill of rights, and occasionally lurks in the fourteenth amendment's equalprotection clause. 2d 93, 1 (1984)(Douglas, J., dissenting).In Re Conroy, 98 N.J. It should be assumed that, initially, medical decisions are based onthe premise that everything can and should be done to preserve the life ofthe patient. See, In Re Conroy, 98 N.J.321, 486 A.2d 12 9 (1985). 417, 43 , 497 N.E.2d 626, 633 (1986); In ReCaulk, 125 N.H. The common-law right to refuse treatment derives from the tortdoctrines of bodily integrity and informed consent. The Saikewicz court stated that the court's interest in preservinglife had to be reconciled with the patient's interest in reducing thetraumatic emotional and physical cost of that preservation. Mill is quoted in Brophy v. Court have recognized that individuals ought to be shieldedfrom unwanted bodily intrusion and have protected this interest by relyingon tort doctrine and the right to privacy. 922 (1976). Harmon, 76 S.W.2d 4 8, 416 n.11 (Mo. 321, 486 A.2d 12 9 (1985).Cruzan v. Mill, On Liberty, in 43 GREAT BOOKS OF THE WESTERN WORLD 27(R. "On Liberty," in Readings in Philosophy of Law. However, a growingnumber of these decisions use the common law doctrine of "informed consent"rather than the constitutional "right to privacy" as the foundation for theevolving right to die. Shaw ed., 1984.In Re Quinlan, 7 N.J. Treatment Plans Hang OnDecision," American Medical News, 24 February 1989, at 3, col. [7]It is estimated that there are five to ten thousand persistentvegetative patients in the United States. As recognized by the principle of autonomy, the patient is the mostappropriate one to make the decision concerning consent to medicaltreatment. The state's interest in preventing suicide was notthreatened in cases where the patient had not set the death-producing agentin motion with the intent to cause his own death and where the patient'sdecision to refuse treatment was not an act of irrational self-destructionbut rather a rational choice because death was imminent. Quoting Justice Cardozo: "Every human beingof adult years and sound mind has a right to determine what shall be donewith his own body; and a surgeon who performs an operation without hispatient's consent commits an assault...." Schloendorff v. [9]Baron, Medical Paternalism and the Rule of Law: A Reply to Dr.Relman, 4 Am.J.L. Because individuals are endowedwith these protected interests, health care providers incur the correlativeduty of respecting patient choice. Thecountervailing state interests: 1) preserving life; 2) protecting innocentthird parties; 3) preventing suicide; and 4) maintaining the ethicalintegrity of the medical profession. Treatment Plans Hang on Decision," American Medical News, 24 February 1989, 3.Baron. Thus, courts need toshift the focus of decision-making authority, by relying on the familialprivacy right, and to articulate a protected interest in the family asdecision maker. 1979): 497.Buchanan. 1988).Griswold v. 479 (1965). In the absence of legislation, the courts have been called upon toannounce doctrinal guidelines for difficult decisions. Supreme Court first recognized a general right to privacy inGriswold v. Theoretically, the right to privacy that resideswith the patient must be transferred to the family. Alive? 922 (1976).Webster's New Twentieth Century Dictionary, Unabridged, 1979.Webster v. A constitutional right to refuse life-sustaining medical treatment isa recent development following on the heels of the Supreme Court'srecognition of the constitutional right to an abortion. Reproductive Health Service, 1 9 S. Hutchens ed. 1 ,4 , 355 A.2d 647, 663 (1976), cert.denied, 429 U.S. 92,93 (1914). denied, 429 U.S. 1988). There are severaladvantages to simply recognizing and protecting the family's decision. Another advantage isthat the family must live with the medical care decisions that are made. [13]Griswold v. "Ethicists Try to Define Status of Vegetative Patient: Dead? The medicalprofessions's ability to sustain patients on the cusp of death producesheartbreaking cases where patients suffer from terminal illnesses or lie inirreversible comas, sustained by a brave new world of respirators,monitors, and feeding tubes, but enjoy no hope of recovering to lead anormal existence. at 42, 355 A.2d at 664. 1988). The common-lawpresumption of bodily integrity draws support from John Stuart Mill's oft-cited assertion that state powers may not be exercised over members of acivilized community except to prevent harm to others.[1 ]To protectpatient's interest in the integrity of their bodies and to protectphysicians from liability for battery, the doctrine of informed consentrequires physicians to inform patients of the risks of proposed treatmentand obtain their consent before they administer any treatment. The right toprivacy has been extended to autonomous decisions, particularly wherebodily integrity is at stake. [5]Kamen, "When Exactly Does Life End," Washington Post, 18 September1989, at 31 (national weekly ed.). & Med. Thus, it is psychologically easier for a doctor to do everythingtechnically possible for the care of the patient and it may be easier for ajudge to allow this to happen. Connecticut, 381 U.S. 97 (1979). Issues of Guardianship. Autonomy is also protected by the right to privacy. The first right todies cases spoke in terms of a constitutionally protected right to declinemedical treatment (In Re Quinlan). 3 4 (1989).----------------------- [1]In Re Quinlan, 7 N.J. Ct. D. Since the, one court has characterizedthe desire to terminate one's life as probably the ultimate exercise of theright to privacy. The Court has respondedthat its role is not to remove political divisive issues from the ambit ofthe legislature, but to hold the balance between powers that theConstitution grants to the judiciary and the powers that it grants to thelegislature.[11] Using the constitutional right to privacy as the basis for the rightto refuse life-sustaining medical treatment may even foreclose consent-based legislative alternatives, because a legislature must assert a morecompelling state interest when it seeks to regulate rights which areguaranteed in the constitution than when it seeks to regulate rights whichare derived from the common law.[12] These decisions reveal a need forlegislatures to fashion legislation guiding patients, their families, andtheir health-care providers to determine when patients humanely mayexercise that right while respecting the state interests arrayed againstit. [12]In Re Jobes, 1 8 N.J. 1 ,4 , 355 A.2d 647, 663 (1976), cert. Finally thestate's interest in maintain the ethical integrity of the medicalprofession is lessened by prevailing medical standards that recognize thatdying patients need comfort more often than treatment. 226, 236,48 A. Reproductive Health Service, 1 9 S. Oneadvantage is practicality (a decision will be made). Alive? A sense of personal failure and responsibility for the death maycause. The state'sinterest in protecting third parties usually concerned minor children whomight be emotionally or financially harmed by a parent or guardian'sdecision to die. [1 ]J.S. A court may sometime soon write an opinion holding that the family'schoice is to be respected and accorded legal status. The judiciary's proper role in balancing competing rights andresponsibilities is particularly difficult when it considers unenumeratedrights such as the constitutional right to privacy. [4]381 U.S. TRIBE,AMERICAN CONSTITUTIONAL LAW 15 (2D ED. [2]Black's Law Dictionary (5th ed. [11]Webster v. 125, 129-3 , 1 5 N.E. 226, 236, 48 A.2d 93, 1 (1984)(Douglas,J.,dissenting);Cruzan v. Society of N.Y.Hospital, 211 N.Y.

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