Guidelines for state court decision making in life-sustaining medical treatment cases.

Need for and Inception of Project Only twenty-five years ago, a decision regarding life-sustaining medical treatment (hereinafter LSMT) (2) was the exclusive province of the patient, (3) the patient's family, and the treating physician. This began to change when the New Jersey Supreme Court handed down the first judicial "right-to-die" opinion in 1976, in the well-known case of Karen Ann Quinlan. (4) The extensive publicity attendant upon this and ensuing cases has sometimes made it seem that the courts have become the primary decision makers in such matters. A series of appellate court opinions have been issued, (5) generally preceded by great anticipation and followed by close review and scrutiny. When the U.S. Supreme Court issued its opinion in Cruzan v. Director, Missouri Department of Health, (6) this growing national attention to judicial opinions regarding LSMT reached new heights. (7) Ironically, during this same time, many courts issuing such opinions took great pains to limit the role of the judiciary in making LSMT decisions and explain why they felt a greater role for the judiciary was inappropriate. In general, they argued that LSMT decisions are inherently private medical decisions and are best resolved through discussions among the treating physician, the patient, and the family and friends of the patient. (8) Typically, these courts considered judicial intervention appropriate only as a matter of last resort when there are irreconcilable differences between the decisionmakers. However, little is known about the role of the courts in the LSMT decision-making process. Limited insight has been provided on how frequently courts are called upon to resolve LSMT cases, what kind of issues are raised in the course of these cases, what kinds of difficulties they face in resolving such cases, how they feel about these cases, or what steps courts can and should take in order to handle these cases appropriately. (9) In order to begin to address these issues, the Natioanl Center for State Courts undertook a two-year project to determine the role of the courts in the LSMT decision-making process and to generate guidelines to assist state court judges asked to review or make decisions involving the authorization or forgoing of LSMT. The project is known as the Decision Making Regarding Life-Sustaining Medical Treatment Project (hereinafter DRLMT). Support was provided by a grant from the State Justice Institute. The initial impetus for undertaking the project was provided by the Conference of Chief Justices (hereinafter CCJ) through its Committee on Decisionmaking on Authorizing and Withholding Life-Sustaining Medical Treatment, which passed a resolution after considerable deliberation and study stating that there was a need to explore and develop principles and practical guidelines for judicial decision making in LSMT cases. Coordinating Council on Life-Sustaining Decision Making and Project Staff This project relied heavily on a twelve-member, multidisciplinary advisory body, the Coordinating Council on Life-Sustaining Decision Making (hereinafter Coordinating Council). The Coordinating Council was chaired by the Hon. Douglas K. Amdahl, Chief Justice of Minnesota (retired), with Hon. Sol Wacthler, Chief Judge of New York, vice-chair. Three other judges, all trial judges, were also involved: the Hon. Robert C. Bibb, from the Washington Superior Court, Snohomish County; the Hon. Hilda R. Gage, from the Michigan Circuit Court, Sixth Judicial Circuit, Pontiac, Michigan; and the Hon. Francis G. Poitrast, Chief Justice of the Juvenile Court Department in Boston, Massachusetts. The other members of the Coordinating Council represented a wide range of disciplines and expertise. They included Professor Alexander Capron, professor of law and medicine, University of Southern California Law Center; Joan McIver Gibson, Ph.D. …