Assisted Suicide and the Right to Die

An individual has a constitutional right to request the withdrawal or withholding of medical treatment, even if doing so will result in the person's death. Honoring a person's right to refuse medical treatment, especially at the end of life, is the most widely practiced and accepted right to die procedure in our society. Recent debates over the futility of certain medical treatments, rationing of treatment and the growth of managed care have caused patients' rights advocates to examine the other side of patient autonomy - the right to request or demand treatment. Some ethicists and health care professionals believe that patient autonomy has already gone too far and should be subject to limitations, and that a patient or a patient's family does not have the right to request treatment that is inappropriate or futile. However, a consensus has not been reached about what constitutes inappropriate or futile treatment. As a result, no explicit blueprints exist for circumstances in which patients and their families disagree with their doctor's advice to abandon treatment. The assumption has been that most health care providers, assured that the law permits them to do so, will respect their patient's decisions, or that of their patient's appointed representative. Because of that erroneous assumption, most advance directive laws have imposed no adverse consequences on providers who do not follow the instructions of an advance directive, and may have advanced the belief among some that noncompliance is legally acceptable. In recent years, the outcomes of medical battery cases in which a health care provider imposes medical treatment contrary to the instructions left in an advance directive may change that climate. Claims of battery against physicians for medical care not requested or agreed-upon have been recognized despite the fact that the medical procedure may have been harmless, beneficial, or life-sustaining. If it was performed without the consent of the patient, or the patient's agent, it can be considered a battery.

One case involving medical futility was the 1992 case of "Baby K," an infant born with anencephaly in a Virginia hospital. Anencephalic babies, who are born missing most of their brain, are treated with comfort measures only. However, "Baby K's" mother insisted on aggressive treatment. The physicians treating her believed that it was inappropriate to pursue aggressive treatment for an anencephalic baby and asked a federal court in Virginia to rule on the case. The court ruled that the hospital cannot deny emergency care to any patient, including "Baby K." Ethicists remain divided on this and other such decisions. Some insist that such painful decisions should be made by those closest to the patient. Others contend that the court's ruling to continue futile treatment threatens the medical profession's integrity. As rising health care costs increasingly become a societal focus, difficult decisions must be faced regarding whether or not patient autonomy should be limited and how. The courts are becoming more and more willing to find that battery has occurred in cases in which a health care provider refused to honor the directions left in an advance directive or given by an appointed agent. This trend may serve to make health care providers more aware of the legal responsibility to honor their patients' right to self-determination.