Precatory Prediction and Mindless Mimicry: The Case of Mary O'Connor

Precatory Prediction and Mindless Mimicry: The Case of Mary O'Connor Nostradamus allegedly said, "Prediction is difficult, especially about the future." For a dozen years a steady stream of appellate courts have forcefully affirmed the right of competent individuals to refuse treatment, and the right of incompetent individuals to have their previously expressed treatment directions followed. I would have predicted New York would join in. Nonetheless, the New York Court of Appeals broke with the trend, rejecting the expressed wishes of a previously competent seventy-seven-year-old widow to refuse the insertion of a nasogastric tube to deliver nourishment to her body. [1] How can this aberrant opinion be explained, and what does it mean for New York's citizens? The Case of Mary O'Connor Mrs. Mary O'Connor is, according to the only two physicians who testified about her condition, "severely demented" and "profoundly incapacitated." She suffered a series of progressively debilitating strokes that have rendered her bedridden, paralyzed, and unable to care for herself, and has been hospitalized or in a nursing home since her latest stroke in December 1987. She responds to some simple questions and commands, but her neurological damage is irreparable, and there is no hope for any significant improvement in her mental or physical condition. Her two daughters, both nurses, have cared for their mother since her health began to deteriorate three years ago. They report that since her last stroke their mother has not responded to them in any way, even by facial expression or movement, although they visit her daily. The hospital to which Mrs. O'Connor was transferred in June asked the daughters for permission to place a nasogastric tube for artificial feeding. Her attending physician "guessed" that this might prolong her life for several months to "perhaps a year or two." The daughters refused on the basis that their mother would not want to be treated under these circumstances. The hospital then sought court authorization to insert the nasogastric tube. The trial court denied the petition on the grounds that there was clear and convincing evidence that Mrs. O'Connor would not want the tube inserted, and the Appellate Division affirmed. A stay was granted permitting Mrs. O'Connor to be fed intravenously during an appeal to the state's highest court. The Court of Appeals reversed and, in an opinion authored by Chief Justice Sol Wachtler, ordered the nasogastric tube inserted because "[o]n this record there is not clear and convincing proof that the patient had made a firm and settled commitment, while competent, to decline this type of medical assistance under circumstances such as these." What Mary O'Connor Wanted Mrs. O'Connor had been employed in hospital administration until 1983, when she retired. Her husband had died of brain cancer, and the last two of her nine brothers died of cancer. She visited all of them regularly and cared for them at home. She had had several conversations with a hospital coworker over the years concerning prolongation of life by artificial means, prompted by deaths and illnesses in their families. Mrs. O'Connor consistently expressed her view that artificial means should not be used to sustain life. In one conversation she stated she would, if ill, never want to be a burden or "lose her dignity," that "nature should take its course" without using "artificial means"; and that it was "monstrous to keep someone alive...by using machinery and things like that when they were not going to get better." She also told her daughters, after her husband died, and again when she was hospitalized for heart failure in 1984, that she "would never want any sort of intervention, any sort of life support system." Her daughters had no doubt that in her present condition their mother would not want her life prolonged by artificial means. …