Court and the End of Life - What Are The Hospital's Rights?

Patricia E. Brophy v. New England Sinai Hospital, Inc.

In 1983 Paul E. Brophy, Sr., suffered an aneurysm (a blood-filled sac formed by dilation of a blood vessel with a weak wall, which makes the vessel more prone to burst) that left him in a PVS. He was not brain dead, nor was he terminal. He had been a fireman and emergency medical technician and often expressed the opinion that he never wanted to be kept alive artificially.

Patricia Brophy brought suit when physicians refused to remove or clamp a gastrostomy tube (g-tube) that supplied nutrition and hydration to her husband. The Massachusetts Appeals Court ruled against Mrs. Brophy, but the Massachusetts Supreme Court allowed substituted judgment for a comatose patient who had previously made his intentions clear.

The Massachusetts Supreme Court, however, did agree with the Massachusetts Appeals Court ruling that the hospital could not be forced to withhold food and water, which went against the hospital's ethical beliefs. Consequently, the Massachusetts Supreme Court ordered New England Sinai Hospital to facilitate Brophy's transfer to another facility or to his home where his wife could carry out his wishes (Patricia E. Brophy v. New England Sinai Hospital, Inc., 497 N.E.2d 626, [Mass. 1986]).

VITALIST DISSENSIONS.

Justices Nolan and Lynch of the Massachusetts Supreme Court strongly disagreed with the majority opinion to allow removal of the gastrostomy tube. Justice Nolan argued that food and water were not medical treatments that could be refused. In his view food and water are basic human needs, and by permitting removal of the g-tube, the court gave its stamp of approval to euthanasia and suicide.

Justice Lynch believed the Massachusetts Supreme Court majority had ignored what he considered valid findings by the Massachusetts Appeals Court which found that Brophy's wishes, as expressed in his wife's substituted-judgment decision of withholding food and water, did not concern intrusive medical treatment. Rather, Brophy's decision, if he were competent to make it, was to knowingly terminate his life by declining food and water. This was suicide and the state was, therefore, condoning suicide. Justice Lynch concluded:

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.

In the Matter of Beverly Requena

Beverly Requena was a competent 55-year-old woman with ALS (Lou Gehrig's disease). She informed St. Clare's/Riverside Medical Center—a Roman Catholic hospital—that when she lost the ability to swallow, she would refuse artificial feeding. The hospital filed a suit to force Requena to leave the hospital, citing its policy against withholding food or fluids from a patient.

Time was running out for Requena. She was paralyzed from the neck down, and unable to make sounds, although she could form words with her lips. At the time of the hearing, she could not eat but could suck some nutrient liquids through a straw. Soon she would not even be able to do that. Judge Stanton described the patient:

Requena seems to have significant pain.… Her body is now almost totally useless. She is trapped within it. Most understandably, she feels enormous frustration and experiences a pervasive sense of helplessness and hopelessness. Her situation is desperately sad.

The court did not question Requena's right to refuse nutrition, nor did the hospital question that right. That was a right that had been upheld in many prior cases. But reasserting its policy of refusing to participate in the withholding or withdrawal of artificial nutrition and hydration, the hospital offered to help transfer Requena to another facility that was willing to fulfill her wishes.

Requena did not want to transfer to another hospital. In the last 17 months, she had formed a relationship of trust in, and affection for, the staff. She also liked the familiar surroundings. The court found that being forced to leave would upset her emotionally and psychologically. The hospital staff was feeling stress as well. They were fond of Requena and did not want to see her die a presumably painful death from dehydration.

SHE DOES NOT HAVE TO LEAVE.

Judge Stanton ruled that Requena could not be removed from the hospital without her consent, and that the hospital would have to accede to her wishes (In the Matter of Beverly Requena 517 A.2d 869 [N.J.Super.A.D. 1986]). He stressed the importance of preserving the personal worth, dignity, and integrity of the patient. The hospital may provide her information about her prognosis and treatment options, but Requena alone had the right to decide what was best for her.

While Judge Stanton noted that Requena's desire to stay at St. Clare's spoke for the compassionate and excellent care she received, he felt the hospital policy to be "coercive." He stated:

There has been a tendency on the part of the Hospital to find a "pro-life" versus "anti-life" issue where one does not exist.… This poor woman is not anti-life and her decision is not anti-life. She would dearly like to be well and to have a decent life.… It is simply not wrong in any sense for this good woman to want relief from her suffering.

As manifested by the evidence in this case, the Hospital rejoices in its specifically Christian heritage. Perhaps it would not be amiss to ask the health care workers … as they turn with loving compassion to the work of helping Beverly Requena, to recall the beautiful words of Jesus: "Come to me, all you who are weary and find life burdensome, and I will refresh you" (Matthew 11:28).