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Limitations on Right and Countervailing Interests

The constitutional right to privacy encompasses the freedom of the terminally ill person who is competent to decide to choose whether or not to decline medical treatment[i].  A patient’s right to refuse medical treatment is primarily protected by the common law and by the federal and state constitutional right of privacy[ii].  Generally, the right to self determination outweighs any countervailing state interests and competent persons can refuse medical treatment even at the risk of death[iii].

However, it is to be noted that the state has a legitimate interest in asserting its parens patriae powers over the mentally and physically incompetent who fails to provide care and cannot safeguard or take care of themselves[iv].  Therefore, the constitutional right to privacy is paramount to a state interest unless that interest outweighs the individual’s constitutional right.  Thus, the right to refuse medical treatment can be overridden by countervailing compelling state interests[v].

In the absence of countervailing state interests, a person has the right to have life sustaining treatment withheld if s/he is:

  • In an advanced stage of a terminal and incurable illness,
  • Suffering severe and permanent mental and physical deterioration.

Similarly, an adult who is incurably and terminally ill possesses a constitutional right of privacy to refuse treatment that only results in prolonging his/her dying process in the absence of any countervailing state interests[vi].

The state can intervene if the interests of the state outweigh the interests of the patient in refusing medical treatment.  Under this circumstance, courts generally consider four state interests[vii]:

  • Preservation of life;
  • Prevention of suicide;
  • Protection of third parties;
  • Ethical integrity of the medical profession.

However, these interests will not override a patient’s refusal of artificially administered food and water normally[viii].

[i] Leach v. Akron General Medical Center, 68 Ohio Misc. 1 (Ohio C.P. 1980)

[ii] In re Farrell, 108 N.J. 335 (N.J. 1987)

[iii] In re Duran, 2001 PA Super 52 (Pa. Super. Ct. 2001)

[iv] In re Eichner on behalf of Fox, 73 A.D.2d 431 (N.Y. App. Div. 2d Dep’t 1980)

[v] In re Eichner on behalf of Fox, 73 A.D.2d 431 (N.Y. App. Div. 2d Dep’t 1980)

[vi] In re Guardianship of Grant, 109 Wn.2d 545 (Wash. 1987)

[vii] Id

[viii] In re Estate of Longeway, 133 Ill. 2d 33 (Ill. 1989)

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