Courts and the End of Life - Competent Patients' Wishes

Satz v. Perlmutter

Not all the cases of patients seeking to terminate life support concern incompetent people. Abe Perlmutter, seventy-three years old, was suffering from amyotrophic lateral sclerosis (ALS; sometimes called Lou Gehrig's disease). ALS is always fatal after prolonged physical degeneration, but it does not affect mental functions.

Perlmutter's 1978 request to have his respirator removed was approved by the Circuit Court of Broward County, Florida. At a bedside hearing, the court questioned whether the patient truly understood the consequences of his request. Perlmutter told the judge that, if the respirator were removed, "It can't be worse than what I'm going through now."

The state appealed the case before the Florida District Court of Appeals (appellate court), citing the state's duty to preserve life and to prevent the unlawful killing of a human being. The state also noted the hospital's and the doctors' fear of criminal prosecution and civil liability. In Michael J. Satz, State Attorney for Broward County, Florida v. Abe Perlmutter (Fla. App., 362 So.2d, 160, 1978) the appellate court concluded that Perlmutter's right to refuse treatment overrode the state's interests, and found in Perlmutter's favor.

THE STATE'S INTERESTS

An individual's right to refuse medical treatment is generally honored as long as it is consistent with the state's interests, which include:

• Interest in the preservation of life
• Need to protect innocent third parties
• Duty to prevent suicide
• Requirement that it help maintain the ethical integrity of medical practice

In the Perlmutter case the Florida District Court of Appeals found that the preservation of life is an important goal, but not when the disease is incurable and causes the patient to suffer. The need to protect innocent third parties refers to cases in which a parent refuses treatment and a third party suffers, such as the abandonment of a minor child. Perlmutter's children were all adults and Perlmutter was not committing suicide. Were it not for the respirator, he would be dead; therefore, disconnecting it would not cause his death but would result in the disease running its natural course. Finally, the court turned to Quinlan and Saikewicz to support its finding that there are times when medical ethics dictates that a dying person needs comfort more than treatment. The court concluded:

Abe Perlmutter should be allowed to make his choice to die with dignity…. It is all very convenient to insist on continuing Mr. Perlmutter's life so that there can be no question of foul play, no resulting civil liability and no possible trespass on medical ethics. However, it is quite another matter to do so at the patient's sole expense and against his competent will, thus inflicting never-ending physical torture on his body until the inevitable, but artificially suspended, moment of death. Such a course of conduct invades the patient's constitutional right of privacy, removes his freedom of choice and invades his right to self-determine.

The state again appealed the case, this time to the Supreme Court of Florida, which, in Michael J. Satz, etc. v. Abe Perlmutter (Fla., 379 So.2d 359, 1980), supported the decision by the Florida District Court of Appeals.