Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-28T22:26:53.495Z Has data issue: false hasContentIssue false
  • English
  • Français

Silent Decisions: Limits of Consent and the Terminally Ill Patient

Published online by Cambridge University Press:  28 April 2021

Troyen A. Brennan
Get access Rights & Permissions [Opens in a new window]

Extract

Over the past decade we have witnessed a remarkable change in the courts, and presumably in societys, attitude toward the care of the terminally ill patient. In a series of court decisions, judges have consistently ruled that the terminally ill patient's autonomy must be respected, even if that means limiting the patient's care when that is the patient's wish. Moreover, courts have allowed the incompetent patient's family and doctors, when they agree, to make substituted decisions to limit care, that is, decisions which attempt to replicate the choices that the patient would have made about his own treatment were he able to do so. Courts have not, however, offered guidance on those situations in which the incompetent patient's family and physicians disagree with respect to their recommendations concerning the course of therapy the patient would choose. Most importantly, courts have failed to establish clear limits on professional authority in situations where disagreements occur.

Type
The Silent World
Information
Law, Medicine and Healthcare , Volume 16 , Issue 3-4 , Winter 1988 , pp. 204 - 209
Copyright
Copyright © American Society of Law, Medicine and Ethics 1988

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Katz, J., The Silent World of Doctor and Patient. (New York: Free Press, 1984).Google Scholar
70 N.J. 10 (1976).Google Scholar
Emanuel, E., “A Review of the Ethical and Legal Aspects of Terminating Medical Care. American Journal of Medicine 84 (1988): 291–301.Google Scholar
In re Dinnerstein, 38 N.E.2d 134 (1978); In re Spring, 399 N.E. 2nd 493 (1979).Google Scholar
In re Conroy, 98 N.J. 321 (1985); In re Jobes, 108 N.J. 335 (1987).Google Scholar
Satz v. Perlmutter, 379 So.2d 359 (1980); Bouvia v. Superior Court, 225 Cal Rptr. 297 (1986); In re Farrell, 108 N.J. 335 (1987).Google Scholar
Baron, C.H., “Medical Paternalism and the Rule of Law: A Reply to Dr. Relman”, American Journal of Law and Medicine, 4 (1979): 367–402; Gostin, L., “A Right to Choose Death: The judicial trilogy of Brophy, Bouvia, and Conroy”, Law, Medicine & Health Care, 14 (1986): 198–202.Google Scholar
Brophy v. New England Sinai Hospital, 398 Mass. 417 (1986). In re Peter, 108 N.J. 365 (1987).Google Scholar
Corbett v. D'Alessandro, 487 So.2d 368 (1986). See also supra notes 4,5,6,7.Google Scholar
In re Dinnerstein, supra note 4.Google Scholar
370 N.E. 2nd 417 (1977).Google Scholar
Relman, A., “The Saikewicz Decision: Judges as Physicians”, New England Journal of Medicine 1978;298:508–10.Google Scholar
Baron, , supra note 7.Google Scholar
Annas, G., “Reconciling Quinlan and Saikewicz: Decision-Making for the Terminally Ill Incompetent”, Journal of Law & Medicine 1979;4:301–34.Google Scholar
Schneiderman, L.J. Spragg, R.G., “Ethical Decisions in Discontinuing Mechanical Ventilation”, New England Journal of Medicine, 1988;318:984–8.Google Scholar
Neu, S. Kjellstrand, C.M., “Stopping Long-Term Dialysis: An empirical study of withdrawal of life-supporting treatment”, New England Journal of Medicine 1986; 314:14–20.Google Scholar
Tomlinson, T. Brody, H., “Ethics and Communication in Do-Not-Resuscitate Orders”, New England Journal of Medicine 1988;318:43–46.Google Scholar
Blackhall, L.J., “Must We Always Use CPR?” New England Journal of Medicine 1987;317:1281–5.Google Scholar
Lo, B. Saika, G. Strull, W. Thomas, E. Showstack, J., “Do Not Resuscitate Decisions: A Prospective Study at Three Teaching Hospitals”, Archives of Internal Medicine, 1985;145: 1115–17.Google Scholar
Brennan, T., “Ethics Committees and Decisions to Limit Care: The experience at the Massachusetts General Hospital”, Journal of the American Medical Association, 1988;260:803–807.Google Scholar
Brennan, T., “Incompetent Patients with Limited Care in the Absence of Family Consent: Socioeconomic and clinical parameters”, Annals of Internal Medicine (in press).Google Scholar
Brennan, , supra note 20.Google Scholar
Katz, J., The Silent World of Doctor and Patient (New York, Free Press, 1984) 7.Google Scholar
Id.: 21.Google Scholar
Beauchamp, & Faden, R., A History of Medical Ethics (1985).Google Scholar
Danzon, P., Medical Malpractice, (Harvard Univ. Press, Cambridge, Ma. (1986).Google Scholar
Lo, B. Jonsen, A.R., “Clinical Decisions to Limit Treatment”, Annals of Internal Medicine, 1980;93:764–768.Google Scholar
Bedell, S. Delbanco, T., “Choices about Cardiopulmonary Resuscitation in the Hospital: When do physicians talk with patients?” New England Journal of Medicine, 1984;310:1089–93; Evans, A.L. Brody, B., “The Do-Not-Resuscitate Order in Teaching Hospitals”, Journal of the American Medical Association, 1985;254:2236–39; Younger, S., “Do-Not-Resuscitate Orders: No longer secret, but still a problem”, Hastings Center Report, 1987;17:24–33.Google Scholar
Katz, J., The Silent World of Doctor and Patient, (New York, Free Press, 1984) 119.Google Scholar
Id.: at 175.Google Scholar
Id.: 198.Google Scholar
Lee, M. Cassel, C., “The Ethical and Legal Framework for the Decision Not to Resuscitate”, Western Journal of Medicine, 1984:140:117–122. See also Lo and Jonsen, supra note 27; Lo, B. Steinbrook, R.L., “Deciding Whether to Resuscitate”, Archives of Internal Medicine, 1983; 143:1561–3; Lipsky, M.S., “Indications for DNR Orders: A Review”, Resident and Staff Physician 1986; Oct.:47–51.Google Scholar
“It's Over, Debbie, A Piece of My Mind,” JAMA, 1988;259:272; Gaylin, W. Kass, L. Pellegrino, E. Siegler, M., “Doctors Must Not Kill”, JAMA, 1988;259:2139–40; Miller, F. Annas, G., “It's Over Debbie [letter], JAMA, 1988;259:2095.Google Scholar
Mariner, W., “Prospective Payment for Hospital Services: Social responsibility and the limits of legal standards”, Cumberland Law Review, 1987;17:379–401.Google Scholar
Bayer, R.et al, “The Care of the Terminally Ill: Morality and economics”, New England Journal of Medicine, 1983;309: 1490–4.Google Scholar
Scitovsky, A. Capron, A.M., “Medical Care at the End of Life: The interaction of economics and ethics”, Annual Review of Public Health, 1986;7:59–75; Englehardt, H.T. Rie, M.A., “Intensive Care Units, Scarce Resources and Conflicting Principles of Justice, Journal of the American Medical Association, 1986;255:1159–64.Google Scholar
Callahan, D., Setting Limits, (New York, Simon & Schuster, 1987).Google Scholar
Hastings Center, Guidelines on the Termination of Life-Sustaining Treatment and the Care of the Dying, (Indiana Univ. Press, Bloomington, Ind. 1988) 32.Google Scholar
Bayer, et al, supra note 35.Google Scholar
Otten, A.L., “Local Groups Attempt to Shape Policy on Ethics and Economics of Health Issues”, Wall Street Journal, 5/28/88, 3.Google Scholar
Callahan, supra note 37, 177.Google Scholar