Paul Brophy, a 48-year old fireman living in Boston, married to Patricia Brophy for 27 years, suffered a subarachnoid hemorrhage as a result of a ruptured basilar tip aneurysm on March 22, 1983. In order to correct the aneurysm. Brophy underwent major surgery involving a right frontotemporal craniotomy and a clipping of the basilar tip aneurysm. Postoperatively, he never regained consciousness, and has remained in a persistent vegetative state. Subsequent to his surgery of April 6, 1983 and prior to his discharge on June 28, 1983, Brophy received multiple CT scans, which showed a complete infarction (destruction of tissue secondary to lack of blood flow) of his left posterior cerebral artery and infarction of the right temporal lobe of the brain. In January, 1985, Patricia Brophy, with the consent of the five Brophy children, all of whom are adults, petitioned to have all life sustaining treatment removed from her husband, including the discontinuation of all artificial nutrition and hydration.
What decision should the court make?
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References
1.
Commonwealth of Massachusetts, The Probate and Family Court Dept., Norfolk Division, Patricia E. Brophy, guardian of Paul E. Brophy, Plaintiff vs. New England Sinai Hospital, Inc., Defendant, (Oct. 21, 1985), n. 25.
2.
Supreme Court of Massachusetts, Patricia E. Brophy vs. New England Sinai Hospital, Inc., Norfolk, (Sept. 11, 1986), pp. 21–28.
3.
“Irreversible coma” signifies a state of unarousable unresponsiveness, the absence of any psychologically understandable response to external stimulus or inner need from which it can be judged from medical signs that the patient will not recover. “Persistent vegetative state” describes the condition of patients who survive for prolonged periods of time in a comatose condition. Patients in this condition may be “awake” even though their behavior does not demonstrate any evidence of conscious intelligence. Plum and Posner, Diagnosis of Stupor and Coma, (Philadelphia, F.A. Davis, Co., 1972), pp. 5, 6, 233-236. For a more complete definition of the persistent vegetative state cf. Brophy, “Decision of Massachusetts Supreme Court,” p. 4, footnote 4. Also President's Commission on Ethics in Medicine and Research, Deciding to Forego Life-Sustaining Treatment, 1983, pp. 174-75.
4.
American Medical Association Council on Ethics and Judicial Affairs, (March 15, 1986).
5.
“Artificial Prolongation of Life and Exact Determination of the Moment of Death,” Pontifical Academy of Sciences, National Catholic News, (Oct. 30, 1985).
6.
“The Prolongation of Life,”The Pope Speaks, Nov. 24, 1957, Vol. 4 (1958), pp. 393–398.
7.
This traditional definition is contained in several books on medical ethics, cf. Gerald KellyS.J.Medical Moral Problems, (St. Louis, Catholic Hospital Association, 1957), p. 134. C. McFadden, O.S.A. Medical Ethics, (Philadelphia, F.A. Davis, Co., 1964), p. 230.
8.
“Statement on Uniform Rights of the Terminally Ill Act,”NCCB Committee for Pro-Life Activities, (June 26, 1986).
9.
A recent statement of the Congregation for the Doctrine of the Faith, On Euthanasia, (June 26, 1986) indicated that the terms “ordinary and extraordinary” are no longer useful. We would maintain they are still useful if properly understood. Moreover, the substitute terms recommended in the document, “proportionate” and “disproportionate” dispose for consequentialism or proportionalism, questionable moral methods.
10.
AMA Council on Ethics and Judicial Affairs, op. cit.
11.
See Reference 3.
12.
CranfordRolandM.D. quoted in Decision of Massachusetts Supreme Court in Brophy Case, p. 10. Cf. also Levey et al, “Prognosis in Non-traumatic Coma”Annals of Internal Medicine, vol. 14, n. 3 (March, 1981), pp. 293–301.
13.
CranfordRolandM.D. quoted in Decision of Massachusetts Supreme Court in Brophy Case, p. 10. Cf. also Levey et al, “Prognosis in Non-traumatic Coma”Annals of Internal Medicine, vol. 14, n. 3 (March, 1981), pp. 293–301.
14.
Thus the document of the Pontifical Academy of Science states: “If the patient is in permanent coma, irreversible as far as it is possible to predict, (medical) treatment is not required, but care, including feeding, must be provided.” The distinction between medical treatment and care is new in a papal document. Is it a meaningful distinction? Though the name may be different, the effect of artificial feeding is the same. It prolongs life for the comatose person. On the face of it, the statement of the Academy is paternalistic because it does not consider a person's wishes concerning treatment which may have been expressed before the person lapses into coma. Moreover, “circumstances of persons, places, times and cultures” are not considered in the statement. Thus, if one followed the document, one would be required to provide artificial feeding to a patient in permanent coma whether in an acute care hospital in the United States or dying at home in the Australian outback. In sum, the statement of the Pontifical Academy does not help solve the problems it addresses.
