Monday, September 22, 2014
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Fighting for your right to die

Grace Lee, a paralyzed 28-year-old woman with an incurable brain tumor, wants to die. She has repeatedly requested that doctors remove her ventilator and feeding tube, but her parents have filed a lawsuit to prevent that from happening.

Fighting for your right to die

by Erica Cohen

Grace Lee, a paralyzed 28-year-old woman with an incurable brain tumor, wants to die. She has repeatedly requested that doctors remove her ventilator and feeding tube, but her parents have filed a lawsuit to prevent that from happening.  

According to Grace’s attorney, she will die within the next two weeks regardless and is so dependent on machines that she will die within minutes once they are removed. Grace’s parents allege that she is too depressed and heavily medicated to make this decision and that removal of life-sustaining equipment is the equivalent of suicide in their religion.
 
Does Grace have a right to die?
 
Competent adult patients have the right to make medical decisions, including withdrawal of life-sustaining treatment. This right is derived from the legal notions of informed consent and privacy, and from the guarantee of liberty granted by the Constitution, as articulated by the U.S. Supreme Court.
 
The Supreme Court has also declared that the right to die must be balanced against four countervailing government interests that could overcome a patient’s choice: preservation of life, protection of the interests of innocent third parties and vulnerable groups, prevention of suicide, and maintaining the ethical integrity of the medical profession.
 
However, as articulated by the California Court of Appeals, “If the right of the patient to self-determination as to his own medical treatment is to have any meaning at all, it must be paramount to the interests of the patient's hospital and doctors. The right of a competent adult patient to refuse medical treatment is a constitutionally guaranteed right which must not be abridged.”
 
The bottom line legally is that life-sustaining treatment can be withdrawn, but there must be clear and convincing evidence that the patient truly wants it done. The problem is that few people clearly express their preferences before they enter a compromised medical state, when it is often too late.
 
One of the best ways to indicate your wishes and ensure that your doctors and family are fully aware of your end-of-life wishes is to create a legal document known as an “advance directive.” Each state has its own laws governing the advance directives that their residents complete.
 
In Pennsylvania, the law divides them into two parts. The first is a living will, which expresses the patient’s desires regarding specific kinds of life-sustaining treatment, such as the use of feed tubes and ventilators. The second is a health care power of attorney, which appoints another person to make health care decisions if the patient is unable to do so. An advance directive can include either or both of these.
 
However, a survey by the Pennsylvania Medical Society found that an alarming 84 percent of adult Pennsylvanians have not prepared this important document.
 
Advance directives help clarify a patient’s wishes, particularly because they are drafted when the patient is competent and of sound-mind. Therefore, family members and doctors will be less concerned that the decision to discontinue life-sustaining treatment is due to depression or incompetence.
 
Although a New York state court held that Grace Lee’s hospital could remove her life support, Grace has decided to remain on life support in order to appease her parents and her God. Despite a legal right to die, these highly emotional decisions are often fraught with family and religious concerns.
 
There is no way to guarantee that you will not end up in a situation like Grace’s; however, the creation of an advance directive would alleviate some of the burden on you and your family if you are ever in a position where a decision must be made whether to continue life-sustaining treatment. Planning ahead could make all the difference in honoring your wishes.
 
You can click here to download a Pennsylvania advance directive form.

About this blog

The Field Clinic reports and analyzes health care laws, government policies, and political trends that are transforming the care we receive and the way we pay for it. Read more about our panel of bloggers here.

This blog is produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente. Portions of this blog may also be found on Inquirer.com and in the Inquirer's Sunday Health Section.

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Robert I. Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
Jeffrey Brenner, MD Founder of the Camden Coalition of Healthcare Providers, Medical Director of the Urban Health Institute at Cooper University Healthcare
Andy Carter President & CEO, The Hospital & Healthsystem Assoc. of Pa.
Robert B. Doherty Senior Vice President of Governmental Affairs & Public Policy American College of Physicians
David Grande, MD, MPA Assistant Professor of Medicine at the University of Pennsylvania
Tine Hansen-Turton Chief Strategy Officer of Public Health Management Corporation
Drew A. Harris, DPM, MPH Director of Health Policy Program at the Jefferson School of Population Health
Antoinette Kraus Director of the Pennsylvania Health Access Network
Laval Miller-Wilson Executive Director of the Pennsylvania Health Law Project
David B. Nash, MD, MBA Founding Dean of the Jefferson School of Population Health
Mark V. Pauly, Ph.D. Professor of Health Care Management, Business Economics and Public Policy at The Wharton School
Howard J. Peterson, MHA Managing Partner of TRG Healthcare, a national healthcare consulting firm
Donald Schwarz, MD, MPH Deputy Mayor for Health & Opportunity and Health Commissioner for the City of Philadelphia
Paula L. Stillman, MD, MBA Healthcare consultant with special expertise in population health and disease management
Elizabeth A. W. Williams Senior Vice President & Chief Communications Officer for Independence Blue Cross
Krystyna Dereszowska A third-year law student concentrating in health at Drexel
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