Refusing Life-Sustaining Treatment after Catastrophic Injury: Ethical Implications

Quill T.E. , “Death and Dignity—A Case of Individualized Decision Making,” N. Engl. J. Med., 324 (1991): 691–94; Block S. Billings A. , “Patient Requests for Euthanasia and Assisted Suicide in Terminal Illness,” Psychosomatics, 36 (1995): 445–57; Chochinov H.M. , “Desire for Death in the Terminally Ill,” American Journal of Psychiatry, 152 (1995): 1185–91; and Sullivan M. Youngner S. , “Depression, Competence, and the Right to Refuse Lifesaving Treatment,” American Journal of Psychiatry, 151 (1994): 971–78.

Shapiro J. , “No Less Worthy a Life,” in Shapiro J. , No Pity: People with Disabilities Forging a New Civil Rights Movement (New York: Times Books, 1993): Ch. 9; Michel V. , “Suicide by Persons with Disabilities Disguised as the Refusal of Life-Sustaining Treatment,” HEC Forum, 7 (1995): 122–31; and Ridley B. , “Tom's Story: A Quadriplegic Who Refused Rehabilitation,” Rehabilitation Nursing, 14 (1989): 250–53.

Patterson D. , “When Life Support is Questioned Early in the Care of Patients with Cervical-Level Quadriplegia,” N. Engl. J. Med., 238 (1993): 506–09.

For further discussion of Bouvia, see: Annas G. , “When Suicide Prevention Becomes Brutality: The Case of Elizabeth Bouvia,” Hastings Center Report, 14, no. 2 (1984): 20–21; Annas G. , “Elizabeth Bouvia: Whose Space is this Anyway?,” Hastings Center Report, 16, no. 2 (1986): 24–25; and Kane F. , “Keeping Elizabeth Bouvia Alive for the Public Good,” Hastings Center Report, 15, no. 6 (1985): 5–8.

Cruzan v. Director, Missouri Dep't of Health , 497 U.S. 261 (1990).

Satz v. Perlmutter, 362 So. 2d 160 (Fla. App. Ct. 1978), aff'd, 379 So. 2d 359 (Fla. 1980); and In re Requena, No. P-326-86E (N.J. Super. Ct. Ch. Div. Sept. 24. 1986), aff'd per curiam, No. A-442-86T5 (N.J. Super. Ct. App. Div. Oct. 6, 1986). For amyotrophic lateral sclerosis, see In re Farrell, 108 N.J. 335, 529 A.2d 404 (N.J. 1987). For locked in syndrome, see In re Rodas, No. 86PR139 (Colo. Dist. Ct. Jan. 22, 1987), modified, (Colo. Dist. Ct. Apr. 3. 1987). All above cases are cited in Bernat J. , “Competent Patients with Advanced States of Permanent Paralysis Have the Right to Forgo Life-Sustaining Therapy,” Neurology, 43 (1993): 224–25.

Maynard F. Muth A. , “The Choice to End Life as a Ventilator-Dependent Quadriplegic,” Archives of Physical Medicine and Rehabilitation, 68 (1987): 862–64.

Id. A C1 lesion is an injury sustained to the upper part of the spinal cord. The injury results in quadriplegia and ventilatory dependence.

Ridley , supra note 2.

Thobaben J.R. , “The Case of Mr. Sims,” HEC Forum, 7 (1995): 94–109.

Report of the Ethics and Humanities Subcommittee of the American Academy of Neurology, “Position Statement: Certain Aspects of the Care and Management of Profoundly and Irreversibly Paralyzed Patients with Retained Consciousness and Cognition,” Neurology, 43 (1993): 222–23.

Caplan A. Callahan D. Haas J. , “Ethical and Policy Issues in Rehabilitation Medicine,” Hastings Center Report, 17, no. 4 (1987): S1–S20.

Id. at 12.

See, for instance, Kliever L. , ed., Dax's Case: Essays in Medical Ethics and Human Meaning (Dallas: Southern Methodist University Press, 1989).

Rosenberg E. Karides D. , “An Interview with Dax Cowart,” JAMA, 272 (1994): 744–45.

Charlifue S. Gerhart K. , “Behavioral and Demographic Predictors of Suicide after Traumatic Spinal Cord Injury,” Archives of Physical Medicine and Rehabilitation, 72 (1991): 488–92.

Statistics cited from Blumenthal S. , “Suicide: A Guide to Risk Factors, Assessment, and Treatment of Suicidal Patients,” Medical Clinics of North America, 72 (1988): 937–71.

Lee M. Ganzini L. , “Depression in the Elderly: Effect on Patient Attitudes Toward Life-Sustaining Therapy,” Journal of American Geriatric Society, 40 (1992): 983–88.

Sullivan Youngner , supra note 1.

Quill T. Cassell C. Meier D. , “Care of the Hopelessly Ill: Potential Clinical Criteria for Physician Assisted Suicide,” New Engl. J. Med., 327 (1992): 1380–84; and Powell T. Kornfeld D. , “On Promoting Rational Treatment, Not Rational Suicide,” Journal of Clinical Ethics, 4 (1993): 334–35.

Patterson , supra note 3.

Hopkins M. , “Patterns of Self-Destruction among the Orthopedically Disabled,” Rehabilitation Research and Practice Review, 3 (1971): 5–16.

Anon, “Behind a Boy's Decision to Forgo Treatment,” New York Times, June 13, 1994, at A12.

Stone A. , “Psychiatry's Undiscovered Country,” American Journal of Psychiatry, 151 (1994): 953–55.

Bowe F. , Handicapping America (New York: Harper and Row, 1978), as quoted in Longmore P. , “Elizabeth Bouvia, Assisted Suicide and Social Prejudice,” Issues in Law and Medicine, 3 (1987): 141–68.

Gardner B.P. , “Ventilation of Dignified Death for Patients with High Tetraplegia,” British Medical Journal, 291 (1985): 1620–22.

Humphrey D. Wicket A. , The Right to Die: Understanding Euthanasia (New York: Harper and Row, 1986).

Pence G. , “Elizabeth Bouvia and Voluntary Death,” in Classic Cases in Medical Ethics (New York: McGraw-Hill, 1990): Ch. 2.

Coles R. , The Moral Life of Children (Boston: Houghton Mifflin, 1986).