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The Baby K Case: A Search for the Elusive Standard of Medical Care

  • Lawrence J. Schneiderman (a1) and Sharyn Manning (a2)
Extract

An anencephalic infant, who came to be known as Baby K, was born at Fairfax Hospial in Falls Church, Virginia, on October 13, 1992. From, the moment of birth and repeatedly thereafter, the baby's mother insisted that aggressive measures be pursued, including cardiopulmonary resuscitation and ventilator support, to keep the baby alive as long as possible. The physicians complied. However, following the baby's second admission for respiratory failure, the hospital sought declaratory relief from the court permitting it to forgo emergency life support on the grounds that “a requirement to provide respiratory assistance would exceed the prevailing standard of medical care,” and that “because any treatment of their condition is futile, the prevailing standard of medical care for infants with anencephaly is to provide warmth, nutrition, and hydration.” The United States Court of Appeals for the Fourth Circuit ruled in favor of the baby's mother, citing the federal Emergency Medical Treatment and Active Labor Act (popularly known as the “anti-dumping” act), which contained no “standard of care” exception to the requirement to provide “treatment necessary to prevent the material deterioration of the individual's condition.” An appeal to the United States Supreme Court was rejected. The baby died some two and one-half years later of cardiac arrest during her sixth visit to the emergency department of Fairfax Hospital for respiratory failure.

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Notes

1. In the matter of Baby “K,” United States Court of Appeals for the Fourth Circuit-Nos. 93–1899; 93–1923; 93–1924.

2. Emergency Medical Treatment and Active Labor Act (EMTALA), 42 U.S.C. A. §139dd (West 1992).

3. In re Wanglie, No. PX-91–283 (4th Dist.) Hennepin County, Minn., July 1, 1991.

4. In re Doe, 262 Ga. 389, 418 S.W.2d 3 (1992).

5. Kolata, G. Court ruling limits rights of patients: care deemed futile may be withheld. NY Times. 1995, 04 22:6 (col. 6).

6. Helling v. Carey, 83 Wash. 2d 514 P.2d 981 (1974).

7. King, JH. The Law of Medical Malpractice in a Nutshell. 2d. ed.St. Paul, Minn: West Publishing Co. 1986.

8. Kapp, MB. “Cookbook” medicine: a legal perspective. Archives of Internal Medicine 1990;150:496500.

9. See note 6. Helling v. Carey 1974.

10. See note 5. Kolata, 1995.

11. Fleischman, AR, Nolan, K, Dubler, NN et al. , Caring for gravely ill children. Pediatrics 1994;94:433–9.

12. Society of Critical Care Medicine Ethics Committee. Consensus statement on the triage of critically ill patients. JAMA 1994;271:1200–3.

13. Adams, JG, Derse, AR, Gotthold, WE et al. , Ethical aspects of resuscitation. Annals of Emergency Medicine 1992;21:1273–6.

14. Schneiderman, LJ, Jecker, NS, Jensen, AR. Medical futility: its meaning and ethical implications. Annals of Internal Medicine 1990;112:949–54.

15. See note 13. Adams, et al. 1992.

16. Solomon, MZ, O'Donnell, L, Jennings, B et al. Decisions near the end of life: professional views of life-sustaining treatments. American Journal Public Health 1993;82:1425.

17. Wolf, SM. Conflict between doctor and patient. Law, Medicine & Health Care 1988;16:197203.

18. Veatch, RM, Spicer, CM. Medically futile care: the role of the physician in setting limits. American Journal Law and Medicine 1992;18:1536.

19. See note 14. Schneiderman, , Jecker, , Jonsen, 1990.

20. Brett, AS, McCullough, LB. When patients request specific interventions: defining the limits of the physician's obligation. NEJM 1986;315:1347–51.

21. Blackball, LJ. Must we always use CPR? NEJM 1987;317:1281–5.

22. Paris, JJ, Crone, RK, Reardon, F. Physician's refusal of requested treatment: The case of baby L. NEJM 1990;322:1012–5.

23. Tomlinson, T, Brody, H. Futility and the ethics of resuscitation. JAMA 1990;264:1276–80.

24. Jecker, NS. Knowing when to stop: the limits of medicine. Hastings Center Report 1991;21(3):58.

25. Nelson, LJ, Nelson, RM. Ethics and the provision of futile, harmful, or burdensome treatment to children. Critical Care Medicine 1992;20:427–33.

26. Jecker, NS, Schneiderman, LJ. Medical futility: the duty not to treat. Cambridge Quarterly of Healthcare Ethics 1993;2:51–9.

27. Luce, JM. Physicians do not have a responsibility to provide futile or unreasonable care if a patient or family insists. Critical Care Medicine 1995;23(4):760–6.

28. Schneiderman, LJ, Jecker, NS. Wrong Medicine: Doctors, Patients and Futile Treatment. Baltimore: Johns Hopkins University Press, 1995.

29. Annas, GJ. Asking the courts to set the standard of emergency care-the case of Baby K. NEJM 1994;330:1542–5.

30. See note 14. Schneiderman, , Jecker, , Jonson, 1990.

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Cambridge Quarterly of Healthcare Ethics
  • ISSN: 0963-1801
  • EISSN: 1469-2147
  • URL: /core/journals/cambridge-quarterly-of-healthcare-ethics
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