Medical Care at the End of Life: A Catholic Perspective

Cases Cited

154 Chapter 8 4. These criteria are proposed in Schneiderman, Jecker, and Jonsen 1990. These authors argue that either a very small probability of medical success (less than 1 to 3 percent or no successes in the last one hundred cases) or an outcome that does not benefit the patient as a whole (the treatment only prolongs the life of an unconscious patient or the treatment maintains life but the patient remains dependent on intensive medical care) is sufficient for declaring a treatment medically futile. They wish these criteria to be independent, so that meeting either one is sufficient. They propose that nutritional support for a patient in a persistent vegetative state be considered medically futile and that physicians withhold or withdraw such support regardless of the wishes of the patient or the family (950). If medical care does not offer patients the opportunity to achieve any of life’s goals, physicians must refuse to give it, regardless of the wishes of patients or surrogates (949, 952–53). In a later article written to answer critics, the authors admit that more empirical outcomes assessment is needed in order to support their proposed approach, but otherwise they continue to propose it (Schneiderman, Jecker, and Jonsen 1996). 5. The Wanglie case is one example. See also Helft, Siegler, and Lantos 2000, 295. These authors quote Daar 1995 as saying that almost every court case of this kind has been resolved in favor of the patient. They list one notable exception, Gilgunn v. Massachusetts General Hospital (1995), but that was a jury decision, not a court ruling. Alexander Morgan Capron analyzes this case and concludes that both judge and jury erred in applying the law; Mrs. Gilgunn’s daughter’s demand that treatment be maintained for her permanently comatose mother should have prevailed (Capron 1995). GLOSSARY advance directives. Declarations, usually written, made by competent people stating which treatments they would want (treatment directives or living wills) or which surrogates they would wish to make the decisions (proxy directives) if they themselves are later incapable of doing so. allowing to die. The forgoing of life-sustaining treatment such that the patient is allowed to die of the underlying condition. It includes both withholding and withdrawing treatment. Contrast with killing. See also pain control. autonomy. Self-rule. The principle or value of making decisions for oneself . One of the four basic principles. beneficence. The principle or value of doing good, of benefitting others (including primarily though not solely the patient). One of the four basic principles. best interests standard. Legally supported standard whereby decisions are made by a surrogate for an incompetent patient based on what is known or thought to be in the patient’s interests (see also substituted judgment standard). competency. Condition of a person whereby he or she is ethically or legally able to make decisions. Strictly, competency is determined by courts and thus the proper term is ‘‘decisional capacity,’’ but ‘‘competency ’’ is usually used. Most ethicists hold for a sliding scale of competency whereby persons who reject beneficial and nonburdensome lifesustaining treatments must be clearly competent to do so whereas minor decisions may be made by marginally competent persons. Determining competency is usually simple but can be very difficult. – 155 – ...