Court Opinion

ID: 9702258
Source: CourtListenerOpinion
Date Created: 2023-08-25 23:03:56.559609+00
Date Added: 2024-06-11T18:21:35.836794
License: Public Domain

O’HERN, J.,
concurring.
“It has been said that ‘[t]he law always lags behind the most advanced thinking in every area. It must wait until the theologians and the moral leaders and events have created some common ground, some consensus.’ ” Superintendent of Belchertown State School v. Saikewicz, 373 Mass. 728, 736, 370 N.E.2d 417, 423 (1977) (quoting Burger, “The Law and Medical Advances,” 67 Annals Internal Med.Supp. 7, 15, 17 (1967)). Hence, In re Conroy, 98 N.J. 321, 387 (1985), did not attempt “to set forth guidelines for decision-making with respect to life-sustaining treatment in a variety of other situations that are not currently before us * * * [because] each case * * * poses its own unique difficulties.”
Consequently, Justice Schreiber counseled:
We do not deem it advisable to attempt to resolve all such human dilemmas in the context of this casé. It is preferable, in our view, to move slowly and to gain experience in this highly sensitive field. As we noted previously, the Legislature is better equipped than we to develop and frame a comprehensive plan for resolving these problems. [Id. at 387-88.]
It was not possible for the trial court in this case to move slowly. The ineluctable deterioration of Kathleen Farrell’s health and the unutterable suffering occasioned by the artificial *361prolongation of her breathing warranted the relief entered by that court. 212 N.J.Super. 294 (Ch.Div.1986).
I
There is no lack of moral, medical, or ethical consensus that a patient and physician, faced with inevitable death that is imminent in spite of the life support means used, need not prolong the suffering occasioned by the use of that means to no human purpose. In such circumstances, the patient may be permitted to choose to discontinue the life-sustaining apparatus, provided that the normal supportive care for the dying patient is continued.
The role of law in this process has been described thus:
Law is one of the basic means through which a society translates its values into policies and applies them to human conduct. Using the general rules embodied in statutes, regulations, and court decisions, society attempts judiciously to balance the degree to which various values may be pursued and to arbitrate situations in which serving one fully justified goal entails failing to serve another. With respect to foregoing life-sustaining treatment, law simultaneously allows such decisions (as an expression of the value of self-determination and well-being), circumscribes the practice (to safeguard well-being), and shapes social institutions and government programs (to advance equity and well-being and to protect self-determination). [President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Deciding to Forego Life-sustaining Treatment 30 (1983) (hereinafter cited as President’s Commission Report).}
In response to our decision in Conroy, the Legislature created a commission to:
a. Clarify the issues posed by a rapidly developing health and science technology and highlight the facts that appear to be most relevant for informed decision making by persons as it relates to their care and treatment;
b. Gather data about how New Jersey and other jurisdictions handle decision making regarding the termination and refusal of care and treatment;
c. Assess the need for additional programs and services relating to medical decision making;
d. Suggest improvements in public policy relating to medical treatment at various levels, not exclusively at the level of State government, and through various means including legislation;
e. Through its reports, offer guidance for people involved in making decisions, though not dictate particular choices on moral grounds. [N.J.S.A. 52:9Y-3.]
*362As we await the report of that commission and any additional legislative implementation, we must continue to hope, as this Court did in In re Quinlan, 70 N.J. 10, cert. denied sub nom. Garger v. New Jersey, 429 U.S. 922, 97 S.Ct. 319, 50 L.Ed.2d 289 (1976), that the case-by-case development of opinions “might be serviceable to some degree in ameliorating the professional problems under discussion.” 70 N.J. at 49. Gradually, such decisions may develop lines of consensus regarding the moral and social values upon which future courts can draw. Baron, “Medicine and Human Rights: Emerging Substantive Standards and Procedural Protections for Medical Decision Making within the American Family,” 17 Fam.L.Q. 1, 22 (1983).
II
In developing that case-by-case analysis, comment on certain features of this case might assist parties in future judicial proceedings.

Shared Decisionmaking

The President’s Commission has stressed in its chapter on “The Elements of Good Decisionmaking” that “patient and provider collaborate in a continuing process intended to make decisions that will advance the patient’s interests both in health (and well-being generally) and in self-determination.” President’s Commission Report, supra, at 43 (footnote omitted). In this case the primary care provider was personally opposed to the decision to withdraw the life-support apparatus. In his conscientious concern for his patient, however, he placed her in contact with a practicing psychologist who arranged for a respiratory specialist to explain to his patient the consequences of turning off the respirator.
In effectuating the patient’s right to exercise an informed consent to medical procedures, it would assist a court to know that the primary care provider has counseled the patient with respect to that decision, which was done in this case. The *363President’s Commission stresses the role of the physician in this decisionmaking process:
The individual health care provider is likely to help dying patients most by maintaining a predisposition for sustaining life (while accepting that prolongation of dying may serve no worthwhile purpose for a particular patient). Indeed, this favoring of life is part of society’s expectation regarding health care professionals. Commonly, it is supported by a personal belief or value commitment and by a recognition of the needs of dying patients for reassurance about the worth of their own lives. [Id. at 48 (footnote omitted).]
However, once it becomes quite clear that the patient is making an informed, deliberate, and voluntary decision to fore-go the specific life-sustaining procedures, then the physician, along with various other individuals, can serve different and valued functions to assist the patient acquiescing in death.
So clear and so overwhelming was Kathleen Farrell’s acceptance of the inevitability of her death that the relief was warranted here. She did not believe that others wished her to die. It was quite clear from her discussions with the trial court that this was her own decision to accept the inevitability of death from the disease that afflicted her.

Sharing The Decisions

One of the hopes of the Quinlan Court was that there would develop, in conjunction with area hospitals, a process to review medical ethical decisions. In the Court’s view, the concept of an ethics committee, which would be readily accessible to those persons rendering care to patients, would be a promising direction for further study of such issues. In re Quinlan, supra, 70 N.J. at 49. Such a panel would have the dual benefit of diffusing the professional responsibility for a decision (comparable, in a way, to the value of multi-judge courts) and insuring the viability of the decisional process. Id. at 50. “In the real world and in relationship to the momentous decision contemplated, the value of additional views and diverse knowledge is apparent.” Ibid.
In In re Conroy, supra, 98 N.J. at 384, in the context of an institutionalized, elderly person, we stated that the involvement *364of two independent physicians for establishing the factual basis of the decision, and the concurrence of the ombudsman and available family members, would assure the correctness of the choice made.
In the context of this case, apart from the hospital setting, such a committee might have provided aid and counsel to a physician and family facing such a decision. The commencement of the decision to discontinue the life-supporting apparatus was first undertaken in November 1985. It was the patient’s first discussion of such a choice. I believe that the availability of such a review panel would reinforce the ability of a guardian ad litem to present to the court any available medically acceptable alternatives that might assist the court in making a decision. As noted in this case, it appears clear that because of the nature of the disease, there were no reasonable alternatives that would have ameliorated the condition of the patient.

Care for the Dying Patient

Once a valid decision to discontinue the life-supporting apparatus has been made, a court should consider its implementation. “[A] decision to forgo particular life-sustaining treatments is not a ground to withdraw all care — nor should caregivers treat it in this way, especially when care is needed to ensure the patient’s comfort, dignity, and self-determination.” President’s Commission Report, supra, at 90. In this case the evidence suggested that Kathleen Farrell would die of suffocation within a matter of minutes if the respirator was disconnected. Hence the normal care due to a dying person described in the President’s Commission Report would be of limited concern.
As noted, Kathleen Farrell’s attending physician personally was opposed to discontinuing the respirator, but he conscientiously agreed to remain in attendance to comfort his patient. In addition, Kathleen Farrell had the service of an around-the-*365clock nursing team. In other cases, I believe that a court will want to assure that care commensurate to the needs of the dying patient will be provided. The care and nurture of the dying, no less than the living, reflects one of the most fundamental aspects of our shared humanity. Provided that the means taken do not in fact add to the suffering and discomfort of the dying patient, as they did both here and in Conroy, the dying person should continue to receive the caring support of health providers.
To repeat, in this case all the evidence indicated that Kathleen Farrell’s death from amyotrophic lateral sclerosis would not be needlessly prolonged and that her physician and her husband would be in attendance. I therefore concur in the judgment.
For affirmance — Chief Justice WILENTZ, Justices CLIFFORD, HANDLER, POLLOCK, O’HERN, GARIBALDI and STEIN — 7.
Concurring in result — Justices CLIFFORD, HANDLER, POLLOCK and O’HERN — 4.