Cases M-R
Martin, Michael
Messenger
People v. Kevorkian; Hobbins v. Attorney General
Planned Parenthood of Southeastern Pennsylvania v. Robert P. Casey
Quinlan, Karen Ann
Roe v. Wade
Rosebush, Joelle
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Martin, Michael
On January 17, 1987, Michael Martin, in his mid-twenties, was in a car-train accident in which he suffered multiple serious injuries, including a closed head injury affecting both hemispheres of his brain. Michael became almost totally paralyzed requiring a colostomy and artificially delivered nutrition and hydration. Because of his significant neurological impairments, he was unable to participate in decisions about his medical treatment. There was some evidence that Michael understood simple concepts and was able to interact with others and his environment to a very limited extent. Michael was not in a persistent vegetative state or terminally ill.
Prior to his accident, Michael had made numerous statements to his wife and co-workers that he would not want to live "like a vegetable" or be totally dependent on machines to live. Accordingly, Mrs. Martin, who had been appointed his guardian, sought to have his artificial nutrition and hydration stopped. The hospital where Michael was receiving treatment at the time for an intestinal obstruction told his wife that it would require a court order to withdraw the artificial nutrition and hydration. Michael’s sisters and mother opposed his wife’s petition to discontinue treatment, and sought to have her removed as his guardian.
The probate court which initially heard the case refused to grant Mrs. Martin’s request for an order to withdraw nutrition and hydration from Michael because he was not in a persistent vegetative state and because his prior statements about his medical treatment preferences were oral and not written. This court refused to remove Mrs. Martin as his guardian. All parties appealed, and in July, 1993, the appeals court instructed the probate court to rehear the matter to determine if Michael was incompetent to make medical treatment decisions. On rehearing, the probate court determined that Michael lacked decision-making capacity and therefore was incompetent. It also determined that his wife was the appropriate guardian and granted her an order to withdraw nutrition and hydration, based on a substituted judgment decision.
Dissatisfied with this result, Michael’s mother and sister appealed the case to the Michigan Supreme Court. On August 22, 1995, the Supreme Court reversed the Appeals Court’s order to remove treatment, holding that life sustaining medical treatment could not be removed from a formerly competent patient who had not made a living will or durable power of attorney for health care unless it could be shown by clear and convincing evidence, under what the Court referred to as a "purely subjective standard," that the patient would not want to receive treatment in the circumstances in which the patient now finds him or her self.
The Court stated that the "predominant factor" in defining clear and convincing evidence is a prior written directive in which the patient describes the situations in which he or she does not want medical intervention. While the Court strongly urged all persons to create written directives, it did not eliminate consideration of oral statements in determining whether evidence of prior wishes is clear and convincing: "[t]he amount of weight accorded to prior oral statements depends on the remoteness, consistency, specificity and solemnity of the prior statement." The court did, however, make the blanket pronouncement that casual statements made in response to seeing or hearing about another’s prolonged death do not fulfill the clear and convincing standard. Their definition of the clear and convincing standard follows:
The decision maker should examine the statement to determined whether it was a well thought out, deliberate pronouncement or a casual remark made in reaction to the plight of another. Statements made in response to seeing or hearing about another’s prolonged death do not fulfill the clear and convincing standard. Only when the patient’s prior statements clearly illustrate a serious, well thought out, consistent decision to refuse treatment under these exact circumstances, or circumstances highly similar to the current situation, should treatment be refused or withdrawn.
Michael Martin had never executed an advance directive (Michigan law does not recognize living wills per se and its Durable Power of Attorney for Healthcare legislation had not yet been enacted). Using the pure subjective test, that is, examining the oral statements that Michael had made to his family and co-workers prior to his accident regarding termination of life-sustaining treatment, the Supreme Court determined that there was not clear and convincing evidence that Michael would have wanted artificial nutrition and hydration stopped in the circumstances in which he now found himself. In the absence of clear and convincing evidence of a patient’s prior intention, the ruling implies that life-sustaining medical treatment should only be discontinued from a formerly competent patient if the patient is suffering from "pain, terminal illness, foreseeable death, a persistent vegetative state, or affliction of similar genre." Because it believed that Michael did not fall within any of these categories, the Court reversed the Appeal Court’s decision to grant Mrs. Martin’s petition to have the treatment discontinued. [Sources: In re Michael Martin, 200 Mich. App. 703, 1993; In re Michael Martin, a Legally Incapacitated Person, Michigan Supreme Court, Nos. 99699, 99700, August 22, 1995; ruling opinion by Conrad L. Mallett (6 votes); dissenting opinion by Charles L. Levin (1 vote).]
Principles & Concepts: autonomy, respect for autonomy, human dignity, informed consent, best interests, sanctity of life, proportionate/ disproportionate means, surrogate decision-making.
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Messenger
This case illustrates the potential for conflicts between health care providers and parents regarding the treatment of severely compromised neonates, even when the parents have a sophisticated understanding of the medical circumstances. Dr. Messenger’s child was born prematurely at 25 weeks gestation. The child was placed on life support, against the parent’s wishes. Dr. Messenger himself removed life-support from the child, against the physician’s orders, and the child died. Dr. Messenger was subsequently charged and tried for murder in criminal court, from which he was acquitted by jury. To this day, there have been no criminal convictions of physicians involved in the removal of life-support. (See also, the Barber-Nejdl/Clarence Herbert case.) [Source: 15 T.M. Cooley L. Rev. 115 (1998).]
Principles & Concepts: autonomy, human dignity, sanctity of life, substituted judgment, proportionate/ disproportionate means, quality of life, futility.
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People v. Kevorkian; Hobbins v. Attorney General
The Michigan court of Appeals ruled on one circuit decision on the state’s statute against assisted suicide, and two circuit court rulings on violations of that law by Jack Kevorkian. Two of the lower court cases on People v. Kevorkian dismissed charges against Kevorkian, holding that the law was unconstitutional. All three lower court cases held the law to be unconstitutional, and two of the three circuit court judges held that individuals have a constitutional right to commit suicide. The Court of Appeals agreed that the statute was unconstitutional because of Michigan’s constitutional requirement that a statute must have only one objective. The statute in question had two objectives: the first, establishing a commission to make recommendations to the legislature on assisted suicide, and the second criminalizing assisted suicide. The Court of Appeals disagreed with the lower court opinions that there was no constitutional right to commit suicide.
The Supreme Court of Michigan consolidated several cases concerning the criminal responsibility of Jack Kevorkian and a case brought by a terminally ill person and others seeking to have Michigan’s criminal statute on assisted suicide declared unconstitutional. The ruling opinion held that the statute was validly enacted, and that the imposition of criminal responsibility by a state on those who assist others in suicide did not violate the U.S. Constitution (see also: Vacco v. Quill and Washington v. Glucksberg). It also held that assisting suicide might be tried as a common law felony, but that a murder charge would require that the death be a direct result of the defendant’s action. In the subsumed case in which Kevorkian filed to have the case dismissed because he allegedly assisted in the suicide in question prior to the statute, the circuit court was instructed to reconsider the motion if there was sufficient evidence to try the case on common law felony charges. [Source: People v. Kevorkian; Hobbins v. Attorney General, 527 N.W.2d 714 (Mich. 1994).]
Principles & Concepts: human dignity, respect for persons, beneficence, autonomy, informed consent, right to die.
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Planned Parenthood of Southeastern Pennsylvania v. Robert P. Casey
Abortion clinics and physicians challenged the constitutionality of 1988 and 1989 amendments to Pennsylvania’s abortion statutes, claiming they violated the due process clause of section one of the Fourteenth Amendment. The U.S. District Court, Eastern District of Pennsylvania (744 F.Supp. 1323) agreed that several sections of the statute were unconstitutional. Upon appeal, the 3rd Circuit Court (947 F.2d 682) affirmed in part and reversed in part the lower court ruling. The case was appealed to the U.S. Supreme Court, which held: 1) that the doctrine of stare decisis (the rule of precedence) requires reaffirmation of Roe v. Wade’s essential holding, that recognizes a woman’s legal right to choose an abortion before fetal viability; 2) that the "undue burden" test should be modified according to fetal viability, rather than the third trimester framework; 3) that the medical emergency definition in Pennsylvania’s statute was sufficiently broad and did not constitute an undue burden; 4) that the informed consent requirements, the 24-hour waiting period, parental consent provisions, and the reporting and record keeping requirements of the statute did not constitute an undue burden; and 5) that the spousal notification provision did impose an undue burden. The other Justices concurred in part and dissented in part on the ruling, written for the majority by O’Connor, Kennedy and Souter. [Source: Planned Parenthood of Southeastern Pennsylvania, et al., v Robert P. Casey, et al., 112 S.Ct. 2791 (1992).]
Principles & Concepts: human dignity, respect for persons, autonomy, right to life, respect for autonomy.
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Quinlan, Karen Ann
On April 15, 1975, Karen Quinlan lapsed into a coma, apparently as a result of consuming alcohol and drugs. Karen was brought unconscious to a hospital emergency room. After her condition stabilized, feeding required a nasogastric tube (artificial nutrition and hydration) and breathing required a respirator. She was eventually diagnosed as being in a permanent coma, i.e., a permanent vegetative state in current terminology. Karen Quinlan’s father sought court appointment as guardian of her person for the express purpose of authorizing removal of her respirator, whether or not she died as a consequence. He was opposed not only by Karen’s physicians but by the local prosecutor and the state attorney general.
The New Jersey trial court denied Mr. Quinlan’s request to be appointed guardian and also his request to terminate the use of the respirator, holding in effect that the decision was solely that of the attending physicians acting in accordance with prevailing medical standards. It rejected the argument that there is a viable legal distinction between ordinary and extraordinary means to sustain life. The New Jersey Supreme Court reversed the decision and granted Mr. Quinlan’s request. Karen’s physicians gradually weaned her from the respirator during May of 1976. She continued to breathe on her own. Her father did not want artificial nutrition and hydration stopped, though the Supreme Court gave permission for all life-support to be withdrawn. Karen lived another ten years. In its considerations regarding this case, the New Jersey Supreme Court advocated giving decision-making authority to a hospital ethics committee (which were still largely non-existent at the time). As a result of this case, ethics committees grew in number and debate arose regarding their appropriate role and authority. Most experts now agree that any authority an ethics committee has is limited and must appropriately respect the decision-making authority that properly belongs to patients, surrogates, and care-providers. [Source: In Re Quinlan, 355 A.2d. (N.J. 1976).]
Principles & Concepts: human dignity, informed consent, substituted judgment, beneficence, proportionate/ disproportionate means.
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Roe v. Wade
1973 U.S. Supreme Court decision that overturned many laws throughout the United states prohibiting abortion. The court’s decision was based on a "right of privacy" interpretation of the 14th amendment, and maintained that abortion is essentially a medical decision to be made by the physician and patient. The court balanced the woman’s interests in deciding to bear a child with the state’s interest in protecting her health and in protecting fetal life. The court ruled that the fetus was considered only a potential person but not a person with legal rights under the constitution. The decision provided a legislative-like schema that prohibits the states from passing legislation that will restrict a woman’s access to abortion during either the first or second trimester, except that regulation of second trimester abortions is permissible if the intention is to protect the woman’s health. States may, if they choose, prohibit all abortions after the fetus becomes viable (viability being a medical determination), except those intended to safeguard the woman’s life and health. [Source: 410 U.S. 959 (1973).]
Principles & Concepts: autonomy, personhood, human dignity, human rights, right to life, justice.
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Rosebush, Joelle
When Joelle Rosebush was 11 years old, she was involved in a traffic accident that severed her spinal cord at the C-1 level and caused her to go into cardiac arrest. The spinal cord injury left Joelle completely paralyzed from the neck down and unable to breathe without a respirator. The lack of oxygen to her brain during the cardiac arrest destroyed most of Joelle’s cerebral brain function and left her in a persistent vegetative state. More than a year after her accident, Joelle’s parents requested that she be transferred from the nursing home where she had been living to Childrens Hospital for termination of life support measures (ventilator, feeding tube). Staff at the nursing home sought and obtained a temporary restraining order, and later a preliminary injunction, that prevented the transfer and termination of life support. A Michigan trial court which later heard the case dissolved the preliminary injunction and authorized Joelle’s parents to make treatment decisions for Joelle, including termination of life support.
The Oakland County Prosecutor appealed the trial court’s decision to grant Joelle’s parents the authority to make such a decision. After hearing the case, the Court of Appeals stated that an individual’s right to withhold or withdraw life-sustaining medical treatment is an aspect of the common law doctrine of informed consent, which applies to any and all forms of medical treatment, including life-sustaining or life-prolonging medical treatment. The court also confirmed that an individual does not lose the right to accept or decline medical treatment on account of being incompetent or a minor. In such cases where an individual lacks the capacity to make treatment decisions, another individual acting as that person’s surrogate may exercise this right on the patient’s behalf. Specifically, as to minors such as Joelle, the court held that parents speak for their minor children in matters of medical treatment, including decisions to forego, i.e., withdraw or withhold, life-sustaining measures. Accordingly, the court upheld Joelle’s parents’ right to withdraw support measures that were keeping Joelle alive. [Source: In re Joelle Rosebush, 195 Mich. App. 675 (1992).]
Principles & Concepts: informed consent, substituted judgment, best interests, autonomy, proportionate/ disproportionate means.
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