Opinion ID: 1119367
Heading Depth: 1
Heading Rank: 10

Heading: the physicians

Text: [7] Concomitant with the guardian's exercise of the patient's right to refuse treatment is the medical determination that the patient is incurable and will not return to a sapient state. If the patient's condition is hopeless or there is no reasonable possibility of returning to a cognitive, sapient state, the patient's right of privacy outweighs the State's interest in preserving life. Superintendent of Belchertown State Sch. v. Saikewicz, 373 Mass. 728, 370 N.E.2d 417 (1977); Annas, Reconciling Quinlan and Saikewicz: Decision Making for the Terminally Ill Incompetent, 4 Am. J.L. & Med. 367 (1979). The prognosis determination is a medical one. Nonetheless, this prong of the decisionmaking process must also incorporate safeguards. While the vast majority of physicians conscientiously adhere to their professional oaths and view their patients' interests as paramount, such a momentous decision requires some protection against those who might be motivated by other interests. The Quinlan court recommended a hospital ethics committee, made up of physicians, social workers, attorneys and theologians, to oversee this decision. This type of a committee has been criticized, however, for its amorphous character, for its use of nonmedical personnel to reach a medical decision, and for its bureaucratic intermeddling. Annas, at 379; Cantor, Quinlan, Privacy, and the Handling of Incompetent Dying Patients, 30 Rutgers L. Rev. 243, 255 (1977); Collester, Death, Dying and the Law: A Prosecutorial View of the Quinlan Case, 30 Rutgers L. Rev. 304, 320-21 (1977); Hirsh & Donovan, The Right To Die: Medico-Legal Implications of In re Quinlan, 30 Rutgers L. Rev. 267, 280-85 (1977). We agree that such an administrative body does not best serve the desired function. In actuality, what is needed is a prognosis board to confirm the attending physician's diagnosis. See Annas, at 369; Eichner, at 476. Concurrence by professional colleagues, who are not attending physicians but who nonetheless have an understanding of the patient's condition, would protect against erroneous diagnoses as well as questionable motives. See Relman, The Saikewicz Decision: A Medical Viewpoint, 4 Am. J.L. & Med. 233, 242 (1978). Thus, we recommend that in future decisions of this nature, there should be unanimous concurrence from a prognosis board or committee. Such a committee should consist of no fewer than two physicians with qualifications relevant to the patient's condition, plus the attending physician. [7] These physicians should agree there is no reasonable medical probability that the patient will return to a sapient state. [8] Disagreement among the physicians on the prognosis committee may foreclose any action to withhold or withdraw treatment without court intervention. In instances of disagreement, application could be made to the court to resolve the dispute with the aid of expert testimony. Should the testimony show, by clear and convincing evidence, that the patient's condition was incurable and there was no reasonable medical probability of returning to a cognitive, sapient state, the court could then assert the patient's right to refuse treatment. In Bertha Colyer's case, two physicians agreed she was incurable and probably would never recover to a sapient state. Each physician had appropriate qualifications to understand her condition. Moreover, neither physician had treated her previously, therefore neither appeared to have any interest in the decision outside the medical considerations. In this instance, given the lack of existing guidelines, we hold their consensus was sufficient.