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Withdrawal of Treatment

Many end-of-life care cases involve patients who are not legally competent to make a determination about their treatment. These cases involve what is referred to as substituted consent exercised by surrogates, typically family members. The legal scenario is usually the family asking a court to order the withdrawal of treatment. In rarer cases where physicians themselves make decisions and terminate treatment occasionally a criminal action may result.

Background: Norman L. Cantor, Twenty Five Years After Quinlan: A Review of the Jurisprudence of Death and Dying, 29 J. L. MED. & ETHICS 182 (2001) [HTML]

Cases

Conservatorship of Wendland, 110 Cal. Rptr. 2d 412 (2001).[Findlaw] (free registration required) $[Lexis] $[Westlaw]
Summary: This case involves a man who was injured in a drunk driving accident which left him conscious, yet severely disabled. Wendland’s conservator for health care decisions sought to have him removed from the artificial nutrition and hydration systems which kept him alive. The California Supreme Court denied the conservator’s request, holding that “a conservator may not withhold artificial nutrition and hydration from such a person absent clear and convincing evidence the conservator’s decision is in accordance with either the conservatee’s own wishes or best interest.”

Cruzan v. Dir., Mo. Dep’t of Health, 497 U.S. 261 (1990). [LII] $[Lexis] $[Westlaw]
Summary: The parents of Nancy Cruzan, who was in a persistent vegetative state following an automobile accident, sought to remove her nutrition and hydration. The case involved a challenge to Missouri’s requirement that a surrogate seeking to terminate life support proffer clear and convincing evidence of the incompetent’s wishes as to withdrawal of treatment. The Supreme Court held that Missouri’s procedural requirement was not violative of the Constitution and that it reflected Missouri’s interest in preventing erroneous decisions as to withdrawal of support. The parents later successfully presented testimony to a Missouri judge in fulfillment of the clear and convincing standard.

State v. McAfee, 385 S.E.2d 651 (Ga. 1989). $[Lexis] $[Westlaw]
Summary: Quadriplegic who was incapable of spontaneous respiration sought determination that he be allowed to turn off ventilator, resulting in his death. Although the focus of this case was the patient’s right to refuse unwanted medical care, this ruling implies that at least in Georgia, providers may be held accountable for not providing measures that will help to ensure the patient’s comfort or pain management.

Bouvia v. Superior Court, 225 Cal. Rptr.297 (Cal. Ct. App. 1986). [Findlaw] $[Lexis] $[Westlaw]
Summary: Elizabeth Bouvia, a 28-year-old quadriplegic suffering from cerebral palsy, sought to have her feeding tube removed. Noting that she was intelligent and mentally competent, the court held that the decision to discontinue support was solely hers. The court also stated that withdrawal of support is not equivalent to commission of suicide and that no criminal liability would attach to the physicians who honored Bouvia’s request to refuse medical service.

In re Quinlan, 355 A.2d 647 (N.J. 1976). [PDF] $[Lexis] $[Westlaw]
Summary: Joseph Quinlan, the father of Karen Quinlan, a young woman in a chronic and persistent vegetative state following prolonged anoxia, was appointed guardian of his daughter in this decision. The court noted he was the proper party to assert the Constitutional right of privacy held by his daughter which guaranteed her right to terminate treatment. The court granted declaratory relief to Mr. Quinlan, and held that Karen’s life support could be terminated if attending physicians and the hospital ethics committee determined that there was no possibility of Karen recovering from her comatose condition and Karen’s family concurred in that decision.