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The Right and Duty to Die

The Right and Duty to Die. Quinlan. How does the court justify the right of a competent person to refuse medical treatment? Constitutional right Balance right of individual to refuse treatment with state’s right to preserve life Medical ethos of providing aid to the dying.

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The Right and Duty to Die

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  1. The Right and Duty to Die

  2. Quinlan • How does the court justify the right of a competent person to refuse medical treatment? • Constitutional right • Balance right of individual to refuse treatment with state’s right to preserve life • Medical ethos of providing aid to the dying.

  3. Saikewicz-- The state’s countervailing interests • Preservation of life • Pg. 583-589 • Protection of the interest of innocent third parties • Pgs. 593-595 • The prevention of suicide • Pg. 589-90 • Maintaining the ethics of the medical profession • Pgs. 590-93 • Encouraging the charitable and human care of afflicted persons (Bergstedt case, note 1, p.586) • Evaluate each of these

  4. Conroy • How does Conroy expand on the rationale justifying the right of a competent individual to forego medical treatment? • How does Conroy affect the continuing precedential effect of Quinlan?

  5. Cruzan v. Director, Missouri Department of Health • How does Cruzan deal with the question of the right of a competent individual to refuse medical treatment? • Right implicit in the concept of “informed consent.” • Inference from prior decision that the right is embodied in 14th amendment’s protection of life, liberty and property.” • Notion of a “liberty interest.”

  6. Notes and Questions • Would patients be discouraged from seeking care if life-sustaining care could not be withdrawn? • Is there a difference between withholding and withdrawing care legally or morally • What role does cost play in the debate over the right to withhold or withdraw life-sustaining care? • What is the state’s interest in the preservation of human life divorced from the individual’s interest in his/her own life? • If the state has an independent interest, how do we balance it against the interest of the individual?

  7. Notes and Questions • How to Quinlan and Conroy differ on the balancing of state and individual interests? • Consider problem of Mr. Cure on page 588 and questions at end of the note. • What is the difference between the withdrawal of life support and assisted suicide?

  8. Lane v. Candura and DHS v. Northern • What are the facts of Candura and what does the court hold? • What are the facts of Northern and what does the court hold? • What distinguishes the cases?

  9. Notes: Assessing Competence • Should patients have to explain their rationale for rejecting or accepting treatment? • Is an explanation necessary to • Assess competence • What respect should be shown to adolescents’ decisions • Consider Belcher v. Charleston Area Medical Center, pg. 598 • Should patients who tend to vacillate about their medical decisions be required to submit to a waiting period before their decisions are implemented?

  10. In Re Conroy/In re Jobes/Cruzan • How are the patients in Conroy and Jobes alike or dissimilar. • What rules are established in New Jersey for a surrogate decisonmaker to withhold or withdraws life support? • What does Cruzan add to the discussion?

  11. Problems • Family Decisionmaking, pg. 631 note 6 • Should families decisions be controlling? • Disagreement among family members • How resolved • Should some family members hold trump cards? • Should living wills and proxy designations be combined? • What advice do you give clients concerned that they have heard doctors don’t follow living wills?

  12. Problems • Problem, Page 640 • Review the cases on page 644-45. Which ones do you agree with; which ones do you disagree with?

  13. Anderson v. St. Francis-St. George Hospital • What are the facts of this case? • Is continued life a compensable injury? • No • Why? • Even accepting breach of a duty and causation, issue is damages and court finds there is not way to put a price on continued life. • Rejects notion that patient could be awarded damages for pain and suffering flowing from continued life. • Why are courts reluctant to impose damages for providing unwanted treatment?

  14. Physician Assisted Suicide

  15. In re Baby K • What are the facts of this case? • Why, given the medical assessment of futility, is the physician's professional judgment ignored?

  16. In re Wanglie • What are the facts of this case? • Can the patient’s insurer refuse to pay for her continued medical care on the grounds that such care is futile and contrary to medical advice?

  17. In re Bowman • What are the facts of this case?

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