Court Opinion

ID: 9732747
Source: CourtListenerOpinion
Date Created: 2023-08-26 16:33:36.035566+00
Date Added: 2024-06-11T18:26:32.542738
License: Public Domain

O’Connor, J.
(concurring in part and dissenting in part). I agree that the law of the Commonwealth does not require hospitals or medical professionals to take measures contrary to their ethical views concerning their duty to their patients. Therefore, I join the court in affirming that part of the judgment that pertains to the hospital. I sharply disagree, however, that the court should honor the choice, attributed to Brophy by a process of substituted judgment, that his G-tube be removed or clamped. Therefore, I do not join the court in so far as the court sets aside the injunction prohibiting the guardian from authorizing a facility to remove or clamp the tube. Furthermore, I do not join the court in ordering a new judgment designed to effectuate Brophy’s supposed wishes. I would affirm the judgment below in its entirety.
The court’s statement of the trial judge’s findings concerning the choice Brophy would have made, were he competent, “to decline the provision of food and water and to terminate his life,” ante at 427, is critically incomplete. The judge found (findings nos. 97 and 113) that Brophy’s choice “would be to decline the provision of food and water, and thereby terminate *449his life” (emphasis added). The judge deliberately used the word “thereby” to express his finding that Brophy’s primary purpose in declining the provision of food and water would have been the termination of his life, entirely apart from any concern about the treatment’s being intrusive. That fact is clear from the judge’s further finding, also omitted from the court’s opinion, that “Brophy’s decision, if he were competent to make it, would be primarily based upon the present quality of life possible for him, and would not be based upon the burdens imposed upon him by receiving food and water through a G tube, which burdens are relatively minimal, inasmuch as the aforesaid treatment is neither painful nor invasive.” (Finding no. 114.) Nowhere does the court acknowledge that the judge found on abundant evidence that Brophy would have chosen to decline food and water via the G-tube primarily because he wants to die, and not because of a lack of confidence that that procedure would be effective in prolonging his life, or because the procedure would be humiliating, painful, or otherwise burdensome. The omitted finding is crucial to an understanding of this case.
Unlike other cases, typified by Superintendent of Belchertown State School v. Saikewicz, 373 Mass. 728 (1977), and Matter of Conroy, 98 N.J. 321 (1985), this case does not involve an individual’s substituted choice to live for as long as possible without seriously burdensome treatment rather than to undergo such treatment in order to prolong life for a brief and uncertain time. Instead, this case raises for the first time in this Commonwealth the question whether an individual has a legal right to choose to die, and to enlist the assistance of others to effectuate that choice on the ground that, irrespective of the nature of available life prolonging treatment, life in any event is not worth living and its continuation is intolerable.
The court frames the issue as “whether the substituted judgment of a person in a persistent vegetative state that the artificial maintenance of his nutrition and hydration be discontinued shall be honored.” Ante at 419. The court’s statement of the issue, like its statement of the facts, fails to reflect the judge’s finding, binding on this court, that Brophy’s choice would not *450be to avoid treatment he would consider burdensome or ineffective to prolong his life, but, instead, would be to die. Sound analysis requires a precise statement of the issue. In light of the judge’s findings, the precise issue in this case is whether the court shall honor the substituted judgment of a person in a persistent vegetative state that the artificial, effective, and non-burdensome maintenance of his nutrition and hydration be discontinued by others in order to bring about his early death. Suicide is the termination of one’s own life by act or omission with the specific intention to do so. Euthanasia is the termination of another’s life by act or omission, with the specific intention to do so, in order to eliminate suffering. The court must consider whether on the facts of this case legal rights to commit suicide and euthanasia should be recognized. Such rights should never be recognized.
Surely, if one has a right to commit suicide, others have a right to assist him in doing so. The fundamental question, then, is whether the court should recognize a right to commit suicide. This court’s explicit recognition of an individual’s right to be free of nonconsensual invasion of his bodily integrity in Harnish v. Children’s Hosp. Medical Center, 387 Mass. 152 (1982), in no sense implied recognition of a right to commit suicide. Nor was such a right recognized by this court in Saikewicz or by the Supreme Court of New Jersey in Matter of Conroy. In Saikewicz, supra at 753-755, this court held that Saikewicz’s right of self-determination was superior to the State’s interest in the preservation of human life, but in that case there was no suggestion that, were he competent, Saikewicz would have refused treatment specifically for the purpose of ending his life. In light of the facts of that case, this court noted that “[t]he interest in protecting against suicide seems to require little if any discussion.” Id. at 743 n.11. The court’s decision was not a recognition of a right to die, but rather was a recognition of Saikewicz’s right to choose not to undergo treatment that, due to his own special characteristics and the nature of the treatment, would impose “heavy physical and emotional burdens ... to effect a brief and uncertain delay in the natural process of death.” Id. at 744. This court rested its *451conclusion squarely on the uncertainty that the treatment would be effective to prolong Saikewicz’s life, and on the “pain and disorientation [that would be] precipitated by the chemotherapy treatment.” Id. at 754. This court firmly rejected the idea that withholding treatment would be justified on the ground that the quality of Saikewicz’s life was unsatisfactory. Id.
The facts in Matter of Conroy, supra, parallel the facts in this case, with one major distinction. In Matter of Conroy, there was no finding, as there is here, that the ward’s choice would be based primarily on the quality of life possible for the ward. As this court observes, ante at 435, “[i]n that case the court would have refused to force a patient who had less than a year to live to endure the pain of a nasogastric tube used to supply nutrition and hydration.” Most important are the court’s observations in Conroy, at 351, that “people who refuse life-sustaining medical treatment may not harbor a specific intent to die, Saikewicz ... at 743 n.11 . . .; rather, they may fervently wish to live, but to do so free of unwanted medical technology, surgery, or drugs, and without protracted suffering. . . . Recognizing the right of a terminally ill person to reject medical treatment respects that person’s intent, not to die, but to suspend medical intervention at a point consonant with the ‘individual’s view respecting a personally preferred manner of concluding life.’ Note, ‘The Tragic Choice: Termination of Care for Patients in a Permanent Vegetative State,’ 51 N.Y.U. L. Rev. 285, 310 (1976). The difference is between self-infliction or self-destruction and self-determination. See Bym, ‘Compulsory Lifesaving Treatment for the Competent Adult,’ 44 Fordham L. Rev. 1, 16-23 (1975).”
The court states here, ante at 433, that “the State’s interest in preserving life is very high when ‘human life [can] be saved where the affliction is curable.’ Saikewicz, supra at 742. That interest wanes when the underlying affliction is incurable and would ‘soon cause death regardless of any medical treatment. ’ Commissioner of Correction v. Myers, supra at 262. Saikewicz, supra.” It is true, of course, that if the proposed treatment will not be effective to prolong the patient’s life, the State’s concern for the preservation of life is not advanced by *452its insistence on the treatment. The language quoted from Saikewicz, in context, says no more than that. Clearly, the court in Saikewicz did not suggest that the State lacks a legitimate interest in effective means being taken to prolong the life of one who is afflicted with a disease or disability, or that that interest depends on whether the disease is curable or the disability is correctable. Such a suggestion would have contradicted the court’s firm rejection of a rule that “equates the value of life with any measure of the quality of life.” Id. at 754.
In the instant case, the court states: “[W]e make no judgment based on our own view of the value of Brophy’s life, since we do not approve of an analysis of State interests which focuses on Brophy’s quality of life. ... It is antithetical to our scheme of ordered liberty and to our respect for the autonomy of the individual for the State to make decisions regarding the individual’s quality of life. It is for the patient to decide such issues.” Ante at 434. The court’s conclusion that Brophy’s right to discontinue food and water is superior to the State’s interest in preserving human life, ante at 439, appears, then, to be premised on the principle that everyone has an absolute right to commit suicide regardless of any assessment by the court of the quality of the life to be extinguished. If, indeed, that is a correct statement of the court’s reasoning, it necessarily follows that the young as well as the old, the healthy as well as the sick, and the firm as well as the infirm, without exception, have the right to commit suicide, and that others have the right to participate in that act. Such a principle surely departs radically from the policy and tradition of this Commonwealth heretofore and should not be acceptable to a civilized society.
The court makes its own assessment of Brophy’s condition as “helpless.” Ante at 434. It may be, therefore, that the court does not rely exclusively on Brophy’s own evaluation of the quality of his life, and that the court’s evaluation is indeed a relevant factor. If that is the case, then the rule for the future is that the court will determine on a case by case basis whether the quality of life available to the individual who chooses to die justifies a State interest in protecting that life. Whether the *453court is establishing an absolute legal right to commit suicide or a right that depends on judicial measurement of the quality of the life involved, neither principle is consistent with this nation’s traditional and fitting reverence for human life.
Even in cases involving severe and enduring illness, disability and “helplessness,” society’s focus must be on life, not death, with dignity. By its very nature, every human life, without reference to its condition, has a value that no one rightfully can deny or measure. Recognition of that truth is the cornerstone on which American law is built. Society’s acceptance of that fundamental principle explains why, from time immemorial, society through law has extended its protection to all, including, especially, its weakest and most vulnerable members. The court’s implicit, if not explicit, declaration that not every human life has sufficient value to be worthy of the State’s protection denies the dignity of all human life, and undermines the very principle on which American law is constructed. I would affirm the judgment below.