Opinion ID: 2402992
Heading Depth: 2
Heading Rank: 3

Heading: The State's Interests

Text: Neither the right to refuse treatment nor the right to privacy are absolute; each must be balanced against the State's interests to the contrary. Four state interests have been identified: preservation of life, prevention of homicide and suicide, the protection of interests of innocent third parties and the maintenance of the ethical integrity of the medical profession. See Section 459.055(1), RSMo 1986; Brophy, 497 N.E.2d at 634. In this case, only the state's interest in the preservation of life is implicated. The state's interest in life embraces two separate concerns: an interest in the prolongation of the life of the individual patient and an interest in the sanctity of life itself. As to the former, The concern for preservation of the life of the patient normally involves an interest in the prolongation of life. Thus, the State's interest in preserving life is very high when human life [can] be saved where the affliction is curable. Saikewicz, ... 370 N.E.2d at 425-426. That interest wanes when the underlying affliction is incurable and would soon cause death regardless of any medical treatment. Commissioner of Corrections v. Myers, [379 Mass. 255] 399 N.E. 2d 452, 456 (Mass.1979). Saikewicz, supra . The calculus shifts when the issue is not whether, but when, for how long, and at what cost to the individual that life may be briefly extended. Id. [370 N.E.2d] at 426. Brophy, 497 N.E.2d at 635 (emphasis added). The state's interest in prolonging life is particularly valid in Nancy's case. Nancy is not terminally ill. Her death is imminent only if she is denied food and water. Medical evidence shows Nancy will continue a life of relatively normal duration if allowed basic sustenance. The state's concern with the sanctity of life rests on the principle that life is precious and worthy of preservation without regard to its quality. This latter concern is especially important when considering a person who has lost the ability to direct her medical treatment. In such a circumstance, we must tread carefully, with due regard for those incompetent persons whose wishes are unknowable but who would, if able, choose to continue life-sustaining treatment. Any substantive principle of law which we adopt must also provide shelter for those who would choose to liveif able to choosedespite the inconvenience that choice might cause others. At the beginning of life, Missouri adopts a strong predisposition in favor of preserving life. Section 188.010, RSMo 1986, announces the intention of the General Assembly of Missouri to grant the right to life to all humans, born and unborn.... Section 188.015(7), RSMo 1986, determines that a fetus is viable when the life of the unborn child may be continued indefinitely outside the womb by natural or artificial lifesupport systems  (emphasis added). Section 188.130, RSMo 1986, denies a cause of action for wrongful life and wrongful birth. At the end of life, this State maintains its policy strongly favoring life. In response to the dilemmas which attend the increasing ability of medical science to maintain life where death would have come quickly in former days, legislatures across the country adopted so-called Living Will statutes. These permit a competent person to decree in a formal document that she would refuse death prolonging medical treatment in the event of terminal illness and an accompanying inability to refuse such treatment as a result of incompetency. The Uniform Rights of the Terminally Ill Act (URITA) provided the basis for many of these acts. Missouri's statute, Sections 459.010, et seq., RSMo 1986, is modeled after URITA, but with substantial modifications which reflect this State's strong interest in life. URITA defines life-sustaining treatment as any medical procedure or intervention that, when administered to a qualified patient, will serve only to prolong the dying process. URITA § 1(4). Missouri chose to call such treatment a death-prolonging procedure which is defined as any medical procedure or intervention which, when applied to a patient, would serve only to prolong artificially the dying process and where, in the judgment of the attending physician pursuant to usual and customary medical standards, death will occur within a short time whether or not such procedure is utilized. Death-prolonging procedure shall not include the administration of medication or the performance of medical procedure deemed necessary to provide comfort care or to alleviate pain nor the performance of any procedure to provide nutrition or hydration. Section 459.010(3), RSMo 1986 (emphasis added). URITA defines a terminal condition as an incurable or irreversible condition that, without the administration of life-sustaining treatment, will, in the opinion of the attending physician, result in death within a relatively short time. URITA, § 1(9). Section 459.010(6) defines a terminal condition as an incurable or irreversible condition which ... is such that a death will occur within a short time regardless of the application of medical procedures. Section 2 of URITA sets out the recommended form of the declaration as to the termination of life-sustaining treatment. [15] Our General Assembly adds, inter alia, the following statement to the recommended form: It is not my intent to authorize affirmative or deliberate acts or omissions to shorten my life rather only to permit the natural process of dying. Section 459.015.3, RSMo 1986. In a manner consistent with this provision, Section 459.055(5), RSMo 1986, plainly states: Sections 459.010 to 459.055 do not condone, authorize or approve mercy killing or euthanasia nor permit any affirmative or deliberate act or omission to shorten or end life. None of the parties argue that Missouri's Living Will statute applies in this case. First, the law did not take effect until after Nancy's accident. Second, even if the law had been effective, Nancy had not executed a living will. The statute's import here is as an expression of the policy of this State with regard to the sanctity of life. We intend no judgment here as to whether the common law right to refuse medical treatment is broader than the Living Will statute. Beyond the broad policy statement it makes, that statute is not at issue in this case. The trial court erred in finding its provisions unconstitutional.
It is tempting to equate the state's interest in the preservation of life with some measure of quality of life. As the discussion which follows shows, some courts find quality of life a convenient focus when justifying the termination of treatment. But the state's interest is not in quality of life. The broad policy statements of the legislature make no such distinction; nor shall we. Were quality of life at issue, persons with all manner of handicaps might find the state seeking to terminate their lives. Instead, the state's interest is in life; that interest is unqualified.