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Identifying Appropriate Decision-Makers and Standards for Decision

Published online by Cambridge University Press:  29 April 2021

Extract

Judges, like lawyers, love to make disclaimers. So, at the outset, I disclaim any expertise in medicine or bioethics. My views are those of a generalist, a judge who has been required to decide cases involving bioethical questions such as the termination of medical treatment.

As Chief Judge Wachtler has explained, the New York Court of Appeals, like the Supreme Court of Missouri in Cruzan, has decided to require clear and convincing evidence before permitting the termination of life-sustaining treatment for an incompetent patient who is not terminally ill. Other courts, including the New Jersey Supreme Court, have reached a different conclusion.

It is not my purpose today to persuade you that the position of our court is correct. Instead, I propose to look at the Cruzan case to see what it does and does not tell us about the identity of the decision-maker and the standard for decision-making in the termination-of-medical-treatment cases.

Type
Article
Copyright
Copyright © American Society of Law, Medicine and Ethics 1991

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References

Remarks by the Honorable Sol Wachtler, Chief Judge of the New York Court of Appeals, Conference on Medical Decision-Making and the Right to Die After Cruzan, Washington, D.C. (September 15, 1990).Google Scholar
Matter of Westchester County Medical Ctr, 72 N.Y.2d 517, 530–31, 531 N.E. 2d 607, 613 (1988).Google Scholar
See e.g. Matter of Jobes, 108 N.J. 394, 418–20, 529 A.2d 434, 445–47 (1987) (subject to medical confirmation procedures, right of patient in irreversibly vegetative state to refuse life-sustaining treatment may be exercised by patient's family or close friend); Conservatorship of Drabick, 200 Cal. App.3d 185, 208, 245 Cal. Rptr. 840, 855–57, cert. denied, —U.S.—, 109 S.Ct. 399, 102 L.ED.2d 387 (1988) (patient's conservator could order withdrawal of life-sustaining treatment if decision made in good faith based on medical advice and in conservatee's best interest).Google Scholar
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Cruzan, 457 S.Ct. at 2875 n.22 (Brennan, J., dissenting) (citing New York as the only state other than Missouri to require clear and convincing evidence of a patient's desire to terminate life support); see also Gasner, “Right to Die Lives Locally,” The National Law Journal, 13 (July 23, 1990) (the courts of last resort of Maine and New York are the only courts to require “clear and convincing” evidence of the desire to forego medical treatment). Gasner explained that the Supreme Judicial Court of Maine explicitly left undecided the propriety of the substituted judgment standard and did not unequivocally adopt the “clear and convincing” standard of proof for all circumstances. Id. Remarks by the Honorable Sol Wachtler, supra note 1 (noting that New York is “out of step with almost every other state in not applying doctrine of substituted judgment…or…the best interests” test).Google Scholar
See Jobes, 108 N.J. at 418, n.11, 529 A.2d at 446 n.11; Gibbs, , Love and Let Die, Time, 62 (March 19, 1990); Cruzan, 110 S.Ct. at 2869 n.11 (Brennan, J., dissenting).Google Scholar
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