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The Simple Cases

Few termination of life-support cases present irreconcilable ethical problems.[77] Most of the patients involved are going to die relatively quickly, irrespective of treatment. All but a few of the rest will be condemned to a persistent vegetative state, which they have previously rejected as unacceptable. Family members may have personal psychological reasons to resist the termination of life support. These are not compelling, however, because of the patient's inability to contribute either personally or financially to family life. Unlike refusal of curative therapy, there is no compelling ethical basis for a physician or hospital to resist the termination of essentially futile treatment. Once treatment becomes both ineffective and unacceptable to the patient, society's interest is to preserve its resources for other patients.[78]

This leaves a residuum of hard cases, cases such as that of Hector Rodas. Rodas suffered an accidental brain injury that left him mentally competent but otherwise totally dependent on life-support technology. He could neither speak nor swallow. He could respond to yes or no questions by nodding his head, which allowed him to spell out messages with the help of a therapist pointing to letters on a board. By this means, Rodas requested that he no longer be fed or hydrated. The hospital required Rodas, through his lawyer, to seek a court order discontinuing life support. The court ultimately ruled that Rodas could refuse nutrition and hydration while remaining in the hospital.[79]

The physicians and the hospital in this case were reluctant to terminate treatment without a court order, but it is difficult to imagine a court refusing Rodas's request to be allowed to die. According to Mishkin,[80] allowing Rodas to die without a court order is certainly legally proper. Considering the prolongation of Rodas's suffering caused by the court action and his extremely limited prognosis, it may be more than merely legal. In cases such as this one, where none of the stakeholders other than the patient has a compelling interest, the delays and suffering inherent in judicial process make such a course of action ethically questionable.

[77]Weir RF; Gostin L: Decisions to abate life-sustaining treatment for Nonautonomous patients: Ethical standards and legal liability for physicians after Cruzan. JAMA 1990; 264:1846-153.

[78]Callahan D: Setting limits: Ethics and resource allocation. In Lumb PD; Shoemaker WC: Critical Care: State of the Art. 1990.

[79]Miller DH: Right to die damage actions. Denver L Rev 1988; 65:184.

[80]Mishkin DB: You don't need a judge to terminate treatment. J Intensive Care Med 1990; 5(5):5201-4.

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