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The Supreme Court ruling Monday that barred the removal of a life-sustaining tube from a permanently unconscious Missouri woman should have little effect on New Yorkers in similar dilemmas, according to physicians.

Meanwhile, area religious leaders suggested Monday that if you favor the "right to die," the best way to protect that option is to make your wishes known -- in writing, if possible -- while you are able to communicate them.

Physicians interviewed said the decision may place more pressure on states, including New York, to pass legislation allowing residents to write living wills or appoint health-care proxies who could make medical decisions for them if they are unable to do so themselves.

"Missouri's position was reasonable, but from the view of the patient it was unreasonable. The case is all the more reason why people should have living wills or proxies. Proxies are probably the only solution to this problem," said Dr. James P. Nolan, director of medicine at Erie County Medical Center.

By a 114-to-29 vote, the New York State Assembly has passed a bill that allows state residents to voluntarily appoint relatives or friends as health-care proxies who could base their decisions on knowledge of the patient's attitudes about life and death. A Senate version is more conservative.

There is no law in New York authorizing living wills, or written declarations that allow patients to make their wishes known concerning unwanted medical care in the event they become incapacitated. But courts have recognized the living will as a valid declaration.

In its first "right-to-die" case, the Supreme Court ruled that a state's interest in preserving life may overcome the wishes of family members seeking to end the life of a patient in an irreversible coma-like condition.

The justices ruled against the parents of Nancy Cruzan, a 32-year-old woman in a "persistent vegetative" condition, who is being kept alive with food and water supplied through a tube surgically implanted in her stomach. The court said Missouri may require "clear and convincing" proof that Ms. Cruzan wants to die, and such evidence is lacking.

Physicians in New York maintain a similar standard.

"We believe we are perfectly justified in withholding care if it's specifically asked for. The problem is when the wishes of the patient are not completely clear," said Dr. Jack P. Freer, an internist and chairman of the ethics committee at Millard Fillmore Hospitals.

"Most people never address these issues," he said. "Therefore, most people don't make these statements. Even when you have a patient motivated to settle issues ahead of time and a physician willing to spend the time, it's extremely difficult to prepare something that will hold water in the future because of the endless variety of medical problems a patient could face."

Religious leaders agreed the issue is something that people should address while they are in full command of their faculties. But they disagreed on whether the Supreme Court made the correct decision.

"I would feel if there is no longer any dignity in her life, she should be permitted to die," said Dr. Martin L. Goldberg, rabbi of Temple Beth Zion, a Reform congregation.

Reform Judaism, Dr. Goldberg said, views death as a part of life.

"We say death is the final chapter and to keep a person alive under these (extraordinary) circumstances is prolonging death," he said.

Dr. Goldberg pointed out that Orthodox Jews would approve of not taking extraordinary steps to prolong life but would disapprove of halting those steps once they were started.

"They would say that only God has the right to take life," he said.

As a chaplain at Roswell Park Cancer Institute and Buffalo General Hospital, Dr. Goldberg said he suggests to patients that they make their wishes known. He said at Temple Beth Zion he has a file of "living wills" made by congregation members who want life-prolonging treatment withheld if they become incurable with no reasonable expectation of recovery.

Catholic theology supports the Supreme Court decision to keep Ms. Cruzan alive but disagrees with the court's finding that the state has an interest in preserving life.

"We feel the decision today revolved around whether a person has the personal right to entrust to others the decision to terminate life," said Deacon Kenneth J. Barth, director of the Office of Pro-Life Activities for the Buffalo Catholic Diocese. "We don't believe a person has a right to entrust that right to others."

"No one should be allowed to remove the tube unless it is the (expressed) wishes of the person involved," he said.

Deacon Barth said the Catholic Church does not believe the standards of the medical profession, the state's interest in preserving life or the ethics of a health-care facility should be factors in decisions to remove life support.

The Rev. Donald L. Weaver, superintendent of the Buffalo District of the United Methodist Church, said he agreed with both the Supreme Court decision and the interest of the state in preserving life.

"What the state is doing is holding to the sanctity of life," he said.

From his own pastoral experience, Mr. Weaver said, he believes the patient, the family, the pastor and the physician should all be involved in decisions about what do to if a person can be kept alive only by extraordinary means.

"I think it is important, if at all possible, to talk it over ahead of time," he said.

The position of the Evangelical Lutheran Church in America is that people have the right to accept or refuse medical aid and that if patients cannot do it, then a legal guardian can act for them, said the Rev. Paul Mertzlufft, dean of the church's Niagara Frontier Conference.

On that basis, he said, he disagreed with the Supreme Court.

"I think there is confusion on what the sacredness of life is," he said. "I believe the quality of life includes a person's ability to comprehend life. When we become incapacitated to the point where only medical technology keeps us alive, we become medical guinea pigs."

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