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Caring for Incompetent Patients: Is There a Physician on the Case?

Published online by Cambridge University Press:  29 April 2021

Bernard Lo
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Extract

What medical care will I receive if I am too sick to make decisions about my care? Many people worry about this question, particularly about how they can retain control over such decisions. The portrayal in this case of physicians who fail to prescribe adequate pain relief and who feel threatened by active family participation in decision-making only reinforces such concerns. It seems that the hospice movement has had no effect on these physicians. Traditional advice, from wise grandmothers, might be to have a child who is a doctor or who marries a doctor. A more modern suggestion might be to give advance directives about future care. At first reading, this case illustrates the usefulness of both suggestions. But on closer reading the case reveals serious problems with both approaches.

Type
Article
Information
Law, Medicine and Healthcare , Volume 17 , Issue 3 , Fall 1989 , pp. 214 - 220
Copyright
Copyright © American Society of Law, Medicine and Ethics 1989

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References

A report by the Hastings Center, Guidelines on the Termination of Life-Sustaining Treatment in the Care of the Dying. Briarcliff Manor, NY. The Hastings Center, 1987; Lo, B. Jonsen, A.R., “Clinical Decisions to Limit Treatment,” Annals of Internal Medicine 1980, 93:764–68; President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Deciding to Forego Life-Sustaining Treatment, Washington: U.S. Government Printing Office, 1983; Ruark, J. Raffin, T. A., Stanford University Medical Center Committee on Ethics, “Initiating and Withdrawing Life Support,” New England Journal of Medicine 1988, 318:25–30; Wanzer, S.H. Federman, D.D. Adelstein, S.J. et al., “The Physician's Responsibility toward Hopelessly Ill Patients: A Second Look,” New England Journal of Medicine 1989, 320:844–49.Google Scholar
Buchanan, A. Brock, D.W., “Deciding for Others” Millbank Memorial Quarterly 1986, 64 (Supp. 2):17–94.Google Scholar
Hirsch, E.D. Jr., “Counterfactuals in Interpretation,” in Levinson, S. Mailloux, S., eds., Interpreting Law and Literature: A Hermeneutic Reader, Evanston, Northwestern University Press, 1988: 55–68.Google Scholar
In the matter of Mary O'Connor, 72 NY 2nd, 517 (1988).Google Scholar
Matter of Eichner v. Dillon. 52 N.Y.S. 2nd 363, 420 N.E. 2nd 64 (1981).Google Scholar
“Deciding for Others,” supra note 2.Google Scholar
Rhoden, N.K., “Litigating Life and Death,” Harvard Law Review 1988, 102:375–446.Google Scholar
Annas, G.J., “Quality of Life in the Courts: Earle Spring in Fantasyland,” Hastings Center Report 1980, 10:9–10; Annas, , “The Case of Mary Hier: When Substituted Judgment Becomes Sleight of Hand,” Hastings Center Report 1984, 14:23–25; Annas, , “Precatory Prediction and Mindless Mimicry: The Case of Mary O'Connor,” Hastings Center Report 1988, 18:31–33.Google Scholar
Calabresi, G. Bobbit, P., Tragic Choices. New York: W.W. Norton & Co., 1978.Google Scholar
Steinbrook, R. Lo, B., “Decision Making for Incompetent Patients by Designated Proxy,” New England Journal of Medicine 1984, 310:1598–1601.Google Scholar
Hastings Center, supra note 1; Lo, Jensen, , supra note 1; President's Commission, supra note 1; Ruark and Raffin, supra note 1; Wanzer, et al., supra note 1.Google Scholar
Evans, R.W. Manninen, D.L. Garrison, L.P. et al., “The Quality of Life of Patients with End-Stage Renal Disease,” New England Journal of Medicine 1988, 312:553–59; Starr, T.J. Perlman, R.A. Uhlmann, R.F., “Quality of Life and Resuscitation Decisions in Elderly Patients,” Journal of General Internal Medicine 1986, 1:373–79.Google Scholar
Pellegrino, E.G. Thomasma, D.G., For the Patient's Good: The Restoration of Beneficence in Health Care. New York, Oxford University Press, 1988.Google Scholar
Lo, B., “Quality of Life Judgments in the Care of the Elderly,” in Thomasma, D.C. Monagle, J., eds., Medical Ethics: A Guide for Health Care Professionals. Rockville: Aspen Press, 1988: 140–47.Google Scholar
Brophy v. New England Sinai Hospital Inc., 497 N.E. 2nd 626 (Mass. 1986).Google Scholar
Rhoden, supra note 7.Google Scholar
Matter of guardianship of Hamlin. 689 P.2nd 1372, 102 Wash.2nd 810 (1987).Google Scholar
Veatch, R.M., “An Ethical Framework for Terminal Care Decisions,” Journal of the American Geriatric Society 1984, 32:66569.Google Scholar
Levine, R.J., “Medical Ethics and Personal Doctors: Conflicts between What We Teach and What We Want,” American Journal of Law & Medicine 1987, 13:351–64; Toulmin, S., “The Tyranny of Principles,” Hastings Center Report 1981, 11:6–8.Google Scholar
Lo, B., “The Death of Clarence Herbert: Withdrawing Care Is Not Murder,” Annals of Internal Medicine 1984, 101:248–51; Lo, , “Clinical Use of Advance Directives,” in Thomasma, Monagle, , eds., Medical Ethics: A Guide for Health Care Professionals.Google Scholar
Saunders, C.M., “Appropriate Treatment, Appropriate Death,” in Saunders, C.M., ed., The Management of Terminal Disease. London, Edward Arnold, 1978: 1–9.Google Scholar