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Quality of Life and Non-Treatment Decisions for Incompetent Patients: A Critique of the Orthodox Approach

Published online by Cambridge University Press:  29 April 2021

Rebecca S. Dresser  and
John A. Robertson
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Extract

Since the Quinlan decision in 1976, courts and legislatures have made substantial progress in defining rules to govern nontreatment of dying and debilitated patients. For example, the right of the competent patient to refuse necessary care is now widely established, and the legality of withdrawing respirators and even nutrition and hydration from permanently unconscious patients is increasingly recognized.

More difficult questions arise, however, when the patient is neither competent nor permanently unconscious, but instead is in a conscious, severely demented and debilitated state, with experiences that appear quite limited. Thousands of patients in this condition are cared for in private homes, hospitals, and nursing homes, the victims of stroke, senility, Alzheimer's disease, and other illnesses. Even though they usually require only low-tech, minimally supportive care, such patients can impose great stress on their families and high financial costs on the health care system.

Type
Article
Information
Law, Medicine and Healthcare , Volume 17 , Issue 3 , Fall 1989 , pp. 234 - 244
Copyright
Copyright © American Society of Law, Medicine and Ethics 1989

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References

In re Quinlan, 70 N.J. 10, 355 A.2d 647, cert. denied sub nom. Garger v. New Jersey, 429 U.S. 922 (1976).Google Scholar
Although cast in the text in terms of balancing competing interests, the question may also be viewed as one of rights, e.g., do such patients have a right to continued life?Google Scholar
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Preserving life at all costs, even in such extreme states, may be a moral or personal position that some persons adopt, but it does not follow that all persons, including families and doctors, must also adopt it. Given the reasonableness of differing views on the subject and the heterogeneity with which they are held, such a strict view should be left to individual discretion.Google Scholar
It is significant that the orthodox approach may exclude such patients from treatment at the behest of proxy decisionmakers, as the cases of Spring and Hier show. In both cases the courts used the substituted judgment test to find that if these patients were competent, they would have chosen not to be treated. On the other hand, the New York courts have required such a high degree of certainty of what the patient would have chosen that withdrawing treatment except when there is an explicit prior directive becomes impossible. The current interests test would reduce greatly the chance that unjustified overtreatment or undertreatment would occur.Google Scholar