Twenty-Five Years after Quinlan : A Review of the Jurisprudence of Death and Dying

In re Quinlan, 355 A.2d 647 (N.J. 1976).

Death and dying jurisprudence actually predates Quinlan, but Quinlan was a landmark case. See infra note 7.

See, e.g., Foody v. Manchester Memorial Hospital, 482 A.2d 713 (Conn. 1984).

John F. Kennedy Hospital v. Bludworth, 452 So. 2d 921 (Fla. 1984).

In re Severns, 421 A.2d 1334 (Del. 1980).

See, e.g., In re Conroy, 486 A.2d 1209 (N.J. 1985).

In re Torres, 357 N.W.2d 332 (Minn. 1984).

In re Lydia E. Hall Hospital, 455 N.YS.2d 706 (N.Y. Sup. Ct. 1982).

Cruzan v. Director, Missouri Department of Health, 497 U.S. 261 (1990).

Washington v. Glucksberg, 521 U.S. 702 (1997).

McKay v. Bergstedt, 801 P.2d 617 (Nev. 1990).

In re Farrell, 529 A.2d 404 (N.J. 1987).

Satz v. Perlmutter, 362 So. 2d 160 (Fla. Dist. Ct. App. 1978).

A blood transfusion involves a relatively slight physical invasion, but sometimes entails a severe insult to a patient's conscientious religious scruples. In Jehovah's Witnesses' cases predating Quinlan, the courts reached mixed results — sometimes upholding and sometimes rejecting a patient's wish to reject treatment. See Cantor N.L. , “A Patient's Decision to Decline Life-Saving Medical Treatment: Bodily Integrity Versus the Preservation of Life,” Rutgers Law Review, 26 (1973): 228–64, at 230–36.

Post-Quinlan, courts have uniformly upheld an adult's prerogative to reject a blood transfusion. See Public Health Trust v. Wons, 541 So. 2d 96 (Fla. 1989).

Fosmire v. Nicoleau, 551 N.E.2d 77 (N.Y. 1990);.

Goldberg C.K. , “Choosing Life After Death: Respecting Religious Beliefs and Moral Conventions in Near Death Decisions,” Syracuse Law Review, 39 (1988): 1197–265.

In re Conroy, 486 A.2d 1209 (N.J. 1985).

Fosmire v. Nicoleau, 551 N.E.2d 77 (N.Y. 1990). See Peters P.G. , “The State's Interest in the Preservation of Life: From Quinlan to Cruzan,” Ohio State Law Journal, 50 (1989): 891–1010.

Superintendent of Belchertown State School v. Saikewicz, 370 N.E.2d 417 (Mass. 1977).

In re Colyer, 660 P.2d 738 (Wash. 1983).

Bartling v. Superior Court, 209 Cal. Rptr. 220 (Cal. Ct. App. 1984).

Daar J.F. , “A Clash at the Bedside: Patient Autonomy v. A Physician's Professional Conscience,” Hastings Law Journal, 44 (1993): 1241–95.

Application of Georgetown College, 331 F.2d 1000 (D.C. Cir. 1964).

Fosmire v. Nicoleau, 551 N.E.2d 77 (N.Y. 1990).

In re Dubreuil, 603 So. 2d 538 (Fla. Dist. Ct. App. 1992).

Siegler M. Weisbard A.J. , “Against the Emerging Stream: Should Fluids and Nutritional Support Be Discontinued?,” Archives of Internal Medicine, 145 (1985): 129;.

Callahan D. , “On Feeding the Dying,” Hastings Center Report, 13 (Oct. 1983):22.

See, e.g., In re Conroy, 486 A.2d 1209, 1236 (N.J. 1985).

Matter of Mary Hier, 464 N.E.2d 959, 960–65 (Mass. App. Ct. 1984).

Barber v. Superior Court, 195 Cal. Rptr. 484, 491–94 (Cal. Dist. Ct. App. 1983).

Satz v. Perlmutter, 363 So. 2d 160, 162 (Fla. Dist. Ct. App. 1978).

Superintendent of Belchertown State School v. Saikewicz, 370 N.E.2d 417 (Mass. 1977).

Matter of Peter, 529 A.2d 419, 425 (N.J. 1987).

Thor v. Superior Court, 855 P.2d 375 (Cal. 1993).

Compare Zant v. Prevatte, 286 S.E.2d 715 (Ga. 1982)

Singletary v. Costello, 665 So. 2d 1099 (Fla. App. 1996)

(both finding a prisoner's right to hunger strike) with Laurie v. Senecal, 666 A.2d 806 (R.I. 1995),

In re Caulk, 480 A.2d 93 (N.H. 1984),

Van Holden v. Chapman, 450 N.Y.S.2d 623 (N.Y. App. Div. 1982) (all rejecting any such right).

Sunshine S.C. , “Should a Hunger-Striking Prisoner Be Allowed to Die?,” Note, Boston College Law Review, 25 (1984): 423–58.

For a fuller account of this position, see Cantor N.L. Thomas G.C. III , “The Legal Bounds of Physician Conduct Hastening Death,” Buffalo Law Review, 48 (2000): 83–173, at 98–107.

In re Brooks (N.Y. Sup. Ct. 1987) (unpublished opinion).

In re Plaza Health and Rehabilitation Center (N.Y. Sup. Ct. 1984) (unpublished opinion).

Matter of lone Bayer (N.C. 1987) (unpublished opinion).

Byock I. , “Patient Refusal of Nutrition and Hydration: Walking the Ever-Finer Line,” American Journal of Hospice & Palliative Care (March 1995): 8;.

Eddy D. , “A Conversation with My Mother,” JAMA, 272 (July 20, 1994): 179.

See Sorum P.C. , “Limiting Cardiopulmonary Resuscitation,” Albany Law Review, 57 (1994): 617–47.

“CEJA Guidelines for the Appropriate Use of DNR Orders,” JAMA, 265 (1991):1868.

See Koch K.A. Meyers B.W. Sandroni S. , “Analysis of Power in Medical Decision Making: An Argument for Physician Autonomy,” Law, Medicine & Health Care, 20, no. 4 (1992):320–26;.

Jecker N. , “Knowing When to Stop: The Limits of Medicine,” Hastings Center Report, 21 (1991): 5.

Veatch R. Spicer C. , “Medically Futile Care: The Role of the Physician in Setting Limits,” American Journal of Law & Medicine, 18 (1992): 15–36;.

Lantos J. , “The Illusion of Futility in Clinical Practice,” American Journal of Medicine, 87 (July 1989): 81.

See Menikoff J. , “Demanded Medical Care,” Arizona State Law Journal, 30 (1998): 1091–130.

See Veatch Spicer , supra note 22;.

Cantor N.L. , “Can Healthcare Providers Obtain Judicial Intervention Against Surrogates Who Demand ‘Medically Inappropriate’ Life Support for Incompetent Patients?,” Critical Care Medicine, 24, no. 5 (1996): 883–87, at 884.

In re Wanglie, Px-91-283 (4th Judicial District, Hennepin County Minnesota, July 1991).

Gilgunn v. Massachusetts General Hospital (Mass. Superior Court, Suffolk County, April 21, 1995).

Causey v. St. Francis Medical Center, 719 So. 2d 1072 (La. Ct. App. 1998).

See also Menikoff , supra note 23, at 1125–26.

Velez v. Bethune, 466 S.E.2d 627 (Ga. Ct. App. 1995).

Rideout v. Rideout (Pa. Common Pleas 1995) (unpublished opinion).

Matter of Baby K., 832 F. Supp. 1022 (E.D. Va. 1993), aff'd 16 F.3d 590 (4th Cir. 1994), cert. denied 115 S. Ct. 91 (1994).

See Rich B. , “A Prescription for the Pain: The Emerging Standards of Care for Pain Management,” William Mitchell Law Review, 26 (2000): 1–91.

Symposium, “Appropriate Management of Pain: Addressing the Clinical, Legal, and Regulatory Barriers,” Journal of Law, Medicine & Ethics, 24 (1996): 285–421.

New York State Task Force on Life and the Law, When Death is Sought: Assisted Suicide and Euthanasia in the Medical Context (New York: New York State Task Force on Life and Law, 1994).

See Latham S.R. , “Aquinas and Morphine: Notes on Double Effect at the End of Life,” DePaul Journal of Health Care Law, 1 (1997): 625;.

Thomasma D.C. , “Ensuring a Good Death” Bioethics Forum, 13, no. 4 (Winter 1997): 7–15, at 14.

Cantor Thomas , supra note 18, at 126–31.

Washington v. Glucksberg, 521 U.S. 702 (1997).

Vacco v. Quill, 521 U.S. 793 (1997).

Vacco v. Quill, 521 U.S. 793, 808 (1997).

Washington v. Glucksberg, 521 U.S. 702, 780–81 (1997) (Souter, J., concurring).

id. at 750–52 (Stevens, J., concurring).

id. at 736–38 (O'Connor, J., concurring).

id. at 791 (Breyer, J., concurring).

Cantor Thomas , supra note 18, at 116–20.

Fleischman A.R. , “Ethical Issues in Pediatric Pain Management and Terminal Sedation,” Commentary, Journal of Pain & Symptom Management, 15 (1998): 260–65, at 261.

Wennberg R.N. , Terminal Choices: Euthanasia, Suicide, and the Right to Die (Grand Rapids: William B. Eerdsman, 1989): at 105.

Orentlicher D. , “The Supreme Court and Terminal Sedation: Rejecting Assisted Suicide, Embracing Euthanasia,” Hastings Constitutional Law Quarterly, 24 (1997): 947–68;.

Robertson J. , “Respect for Life in Bioethical Dilemmas—The Case of Physician-Assisted Suicide,” Cleveland State Law Review, 45 (1997): 329–43.

See also Cantor Thomas , supra note 18, at 145–51.

Compassion in Dying v. Washington, 79 F.3d 790 (9th Cir. 1996).

Quill v. Koppell, 80 F.3d 716 (2d Cir. 1996).

Washington v. Glucksberg, 521 U.S. 702 (1997).

Vacco v. Quill, 521 U.S. 793 (1997).

Krischer v. McIver, 697 So. 2d 97 (Fla. 1997).

People v. Kevorkian, 527 N.W.2d 714 (Mich. 1994).

Donaldson v. Van de Kamp, 4 Cal. Rptr. 2d 59 (Calif. Ct. App. 1992).

See Pratt D.A. , “Too Many Physicians: Physician-Assisted Suicide after Glucksberg/Quill,” Albany Journal of Law, Science & Technology, 9 (1999): 161–234, at 200–01, 233;.

Quill T. , “Care of the Hopelessly Ill: Proposed Clinical Criteria for Physician-Assisted Suicide,” N. Engl. J. Med., 327 (1992): 1380.

Compare Gomez C. , Regulating Death: Euthanasia and the Case of the Netherlands (New York: The Free Press, 1991).

(opposing physician-assisted suicide) with Griffiths J. Bood A. Weyers H. , Euthanasia & Law in the Netherlands (Amsterdam: Amsterdam University Press, 1998) (favoring physician-assisted suicide).

E.g., Robertson J.A. , “Second Thoughts on Living Wills,” Hastings Center Report, 21, no. 5 (November 1991): 6–9;.

McGee G. , “Paper Shields: Why Advance Directives Still Don't Work,” Princeton Journal of Bioethics, 1, no. 1 (1998): 42–56.

Dresser R. , “Confronting the Near Irrelevance of Advance Directives,” Journal of Clinical Ethics, 5, no. 1 (1994): 55–56;.

Dresser R. Robertson J.A. , “Quality of Life and Non-Treatment Decisions for Incompetent Persons,” Law, Medicine & Health Care, 17 (1989): 234–44.

This language is from a model used by Choice in Dying, a national organization promoting death with dignity (visited June 1, 2000) <http://www.esinteractive.com/ripp/wills-living.html>.

Cantor N.L. , “Making Advance Directives Meaningful,” Psychology, Pubic Policy, and Law, 4 (1998): 629–52, at 646–52.

See Lerner M.J. , “State Natural Death Acts: Illusory Protection of Individuals' Life-Sustaining Treatment Decisions,” Harvard Journal of Legislation, 29 (1992): 175–221.

See Cantor N.L. , Advance Directives and the Pursuit of Death with Dignity (Bloomington: Indiana University Press, 1993): at 48–50;.

Wolf S.M. , “Honoring Broader Directives,” Hastings Center Report, 21, no. 5 (September 1991): S8–S9.

Matter of Tavel, 661 A.2d 1061 (Del. 1995).

But see Wright v. Johns Hopkins Health Systems, 728 A.2d 166, 176–79 (Md.

HCA v. Miller, #14-98-00582-CV (Tex. Ct. App. 2000) (suggesting that statutes such as natural death acts or living will acts provide the exclusive route for removal of life support from now-incompetent patients).

Matter of Westchester County Medical Center, 531 N.E.2d 607 (N.Y. 1988).

DeGrella v. Elston, 858 S.W.2d 698 (Ky. 1993).

Mack v. Mack, 618 A.2d 744 (Md. 1993).

Cruzan v. Harmon, 760 S.W.2d 408 (Mo. 1988).

See also In re Gardner, 534 A.2d 947 (Me. 1987).

Note, however, that the narrow approaches have been changed by judicial interpretation in Missouri (Warren v. Wheeler, 858 S.W.2d 263 (Mo. Ct. App. 1993)) and by statute in Maryland. See Hoffmann D.E. , “The Maryland Health Care Decisions Act: Achieving the Right Balance?,” Maryland Law Review, 53 (1994): 1064–135.

Spahn v. Eisenberg, 543 N.W.2d 485 (Wis. 1997).

In re Martin, 538 N.W.2d 399 (Mich. 1995).

See Filene P. , In the Arms of Others: A Cultural History of the Right to Die in America (Chicago: Ivan R. Dee, 1998): at 109–10.

Courts seem to apply the clear and convincing standard with less rigor if the patient is permanently unconscious. See In re Gardner, 534 A.2d 947, 952–53 (Me. 1987).

Nancy Cruzan herself benefited from this tendency. Upon remand from the Supreme Court, her parents presented additional evidence of her expressed wishes and a trial court authorized the removal of life support. Missouri courts have also interpreted Cruzan narrowly, as applying only to removal of artificial nutrition and hydration. See Warren v. Wheeler, 858 S.W.2d 263 (Mo. Ct. App. 1993).

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

Superintendent of Belchertown State School v. Saikewicz, 370 N.E.2d 417, 423 (Mass. 1977).

John F. Kennedy Memorial Hospital v. Bludworth, 452 So. 2d 921 (Fla. 1984).

In re Colyer, 660 P.2d 738 (Wash. 1983).

In re Fiori, 673 A.2d 905 (Pa. 1995).

Matter of Tavel, 661 A.2d 1061 (Del. 1995).

Estate of Longeway, 549 N.E.2d 292, 299–300 (Ill. 1989).

Brophy v. New England Sinai Hospital, 497 N.E.2d 626, 631–32 (Mass. 1986).

In re Jobes, 529 A.2d 434 (N.J. 1987).

In re Fiori, 673 A.2d 905 (Pa. 1995).

See Wicclair M.R. , Ethics and the Elderly (New York: Oxford, 1993): at 56–60.

Estate of Longeway, 549 N.E.2d 292, 306 (Ill. 1989) (Ward, J., dissenting).

See Pollock S.G. , “Life and Death Decisions: Who Makes Them and by What Standards?,” Rutgers Law Review, 41 (1989): 505–40, at 518–22.

In re Grant, 747 P.2d 445 (Wash. 1987).

In re Conroy, 486 A.2d 1209 (N.J. 1985).

In re Rosebush, 491 N.W.2d 633 (Mich. Ct. App. 1992).

See New York State Task Force on Life and the Law, When Others Must Choose: Deciding for Patients without Capacity (New York: New York State Task Force on Life and the Law, 1992): at 55;.

Strasser M. , “Incompetents and the Right to Die: In Search of Meaningful Standards,” Kentucky Law Journal, 83 (1995): 733–91, at 778.

Dresser R. , “Missing Persons: Legal Perspectives of Incompetent Persons,” Rutgers Law Review, 46 (1994): 609–704, at 666–91.

Peters , supra note 8, at 942.

See Strasser , supra note 64, at 744–45.

President's Commission for the Study of Ethical Problems in Medicine and Biomedical Behavioral Research, Deciding to Forgo Life-Sustaining Treatment: Ethical, Medical and Legal Issues in Treatment Decisions (Washington, D.C.: U.S. Gov't Printing Office, 1983): at 135–36.

Rasmussen v. Fleming, 741 P.2d 674, 684 (Ariz. 1987).

Barber v. Superior Court, 195 Cal. Rptr. 484, 493 (Cal. Ct. App. 1983).

cf. In re R.H., 622 N.E.2d 1071, 1076 (Mass. App. Ct. 1993) (mentioning family interests as a legitimate consideration under a substituted judgment formula).

President's Commission, supra note 67, at 135.

See, e.g., Singer P.A. , “Quality End-of-Life Care: Patients' Perspectives,” JAMA, 281 (1999): 163;.

Lindgren J. , “Death by Default,” Law & Contemporary Problems, 56 (1993):185–254, at 202.

Rasmussen v. Fleming, 741 P.2d 674, 688–89 (Ariz. 1987).

Barber v. Superior Court, 195 Cal. Rptr. 484, 493 (Cal. Ct. App. 1983).

In re Fiori, 673 A.2d 905, 912 n.11 (Pa. 1985).

In re Grant, 747 P.2d 445, 451, 457 (Wash. 1987).

See Cantor N.L. , “Discarding Substituted Judgment and Best Interests: Toward a Constructive Preference Standard for Dying, Previously Competent Patients without Advance Instructions,” Rutgers Law Review, 48 (1996): 1193–272, at 1257–72.

Lindgren , supra note 70.

See Superintendent of Belchertown State School v. Saikewicz, 370 N.E.2d 417 (Mass. 1977).

In re Grant, 747 P.2d 445 (Wash. 1987);.

Lindgren , supra note 70.

Danis M. , “Patients and Families' Preferences for Medical Intensive Care,” JAMA, 260 (1988): 797;.

Hoffmann D.E. , “The Dangers of Directives or the False Security of Forms,” Journal of Law, Medicine & Ethics, 24 (1996): 5–17, at 10–11;.

Singer , supra note 70;.

Pearlman R.A. , “Insights Pertaining to Patient Assessments of States Worse than Death,” Journal of Clinical Ethics, 4 (1993): 35.

Kadish S.H. , “Letting Patients' Die: Legal and Moral Reflections,” California Law Review, 80 (1992): 857–88, at 882.

Cantor , supra note 50, at 646–52.

Cantor , supra note 72, at 1265;.

Schrode K.E. , “Life in Limbo, Revising Policies for Permanently Unconscious Patients,” Houston Law Review, 31 (1995): 1609–79, at 1648–53;.

Lindgren , supra note 70;.

Angell M. , “After Quinlan: The Dilemma of the Persistent Vegetative State,” N. Engl. J. Med., 330 (1994): 1524, 1525.

See Anderson v. St. Francis Hospital, 671 N.E.2d 225 (Ohio 1996);.

Strasser M. , “Wrongful Life, Wrongful Birth, Wrongful Death, and the Right to Refuse Treatment,” Missouri Law Review, 64 (1999): 29–76;.

Milani A. , “Better Off Dead than Disabled?: Should Courts Recognize a Wrongful Living Cause of Action?,” Washington & Lee Law Review, 54 (1997): 149–228.