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Right To Refuse Lifesaving Treatment

Every competent individual has the legal right to refuse lifesaving medical treatment.  Therefore, a health care provider cannot force medical care upon a patient without his/her consent even in life threatening-situations.  The competent adults irreversibly sustained by artificial life support and enduring physical and mental pain and suffering had the right to terminate treatment.  Under such circumstances, the patient’s right to refuse or terminate life-sustaining treatment would override competing state interests in preserving life and the exercise of the right would not amount to suicide.

The courts, in deciding an individual’s right to refuse lifesaving treatment, even if there is a possibility of a cure, consider the competency of the individual as to whether an individual has knowingly and validly chosen such a right, and whether there is a compelling state interest that justifies overriding the individual’s decision.  Where there is a compelling state interest, an individual’s right to refuse medical treatment based on his/her religious beliefs shall not be recognized and the court shall order the proceeding with such treatment.

However, in People v. Brown (In re Brown), 294 Ill. App. 3d 159 (Ill. App. Ct. 1st Dist. 1997), the court held that the State could not override the patient’s competent refusal of treatment decision to save the life of her fetus.  The court found that (1) the case satisfied the public policy of the state mootness doctrine, (2) a blood transfusion was an invasive medical procedure, (3) being a competent adult, the patient had an absolute right to refuse medical treatment, (4) religious objections to treatment were constitutionally protected, (5) the State’s interest in the preservation of life, the prevention of suicide, the protection of third parties, and the ethical integrity of the medical profession did not override the patient’s decision to refuse lifesaving treatment.

Under a compelling state interest, the court may order a lifesaving treatment to an individual where the evidence shows that such individual has a good chance to live if the operation is performed and will die otherwise.  In Superintendent of Belchertown State School v. Saikewicz, 373 Mass. 728 (Mass. 1977), the court found that there is a general right in all persons to refuse medical treatment in appropriate circumstances.

The state’s interest in the preservation of life does not invariably control the right to refuse treatment in cases of positive prognosis.  Therefore, consideration should be given to the nature of the treatment involved, the complexity of the procedures, the extent of the commitment and endurance required of a person who has to undergo the proposed treatment along with the physical and emotional burdens imposed on the patient by compelling him/her to accept such treatment.

However, compelling a patient to take medications does not involve a physical and emotional burden where daily medicines would help in curing the patient completely and therefore the state’s interest in preservation of life would be quite strong.

In Powell v. Columbian Presbyterian Medical Center, 49 Misc. 2d 215 (N.Y. Sup. Ct. 1965), it was found that the court authorized blood transfusions for a member of Jehovah’s Witnesses who was in a critical state and had refused pleas of her husband and family and hospital staff that she sign authorization for blood transfusions.  Nevertheless, while considering the state’s interest in preserving life in blood transfusion cases that can cure the patient’s condition, the court should examine the facts that blood transfusions are not without risk and can result in adverse complications affecting the patient due to impure blood transfusion.

In the case of treatment for particular conditions such as cancer, unless there are any existing state interests, the court cannot compel a patient to undergo such cancer treatment because the conventional treatment methods of cancer are risky, can disfigure a person physically, and cause pain.  However, for treatment related to a kidney disease, the magnitude of the medical invasion occasioned by the treatment compared to treatment by medicines alone is enough to counterbalance the state’s predominant interest in the preservation of life, because the dialysis treatment involves a relatively complex procedure, which requires a considerable commitment and endurance of a patient.

In a majority of cases, courts have upheld the right of an adult to refuse potentially life–saving medical treatment on religious grounds, unless the individual is (1) mentally incompetent, (2) the parent and sole provider of young children, or (3) a pregnant woman.  Where there are minor children dependent upon the survival of the patient, the medical control of one’s body is relative.  Therefore, the need of protection of innocent third parties arises and where there are such minor children dependent on the patient, the court will not recognize the patient’s right to refuse medical treatment even when there is a hope for cure.  But, if the court finds that the interest of the child is not affected and the child will be adequately cared for both financially and emotionally, then the court will not order any such lifesaving treatment.  The court acts according to the state’s interest in protecting children when the lives and health of unborn children is threatened by their mother’s decisions.

In re L.H.R., 253 Ga. 439 (Ga. 1984), the court stated that a competent adult patient has the right to refuse medical treatment in the absence of conflicting state interest and such a right rises to the level of a constitutional right which is not lost because of the incompetence or youth of the patient.  However, the doctrine that every human being of adult years and sound mind has a right to determine what shall be done to his own body was reiterated in Cruzan v. Dir., Mo. Dep’t of Health, 497 U.S. 261, 269 (U.S. 1990).

The medical professionals are not to be forced to ignore the mandates of their own conscience in treating a patient by withholding certain type of medical treatment which run counter to the procedure, such as the administration of blood transfusion in treatment for leukemia.  Also, a patient under no circumstance shall order a doctor to provide treatment that would result in his/her death.  The courts have compelled patients to accept the treatment they wished to reject under situations where the administration of lifesaving treatment is considered necessary and only partial treatment has been authorized.

If an emergency lifesaving situation arises and it is required to save the life of a human being, no one should be deterred from the exercise of sound medical judgment relating to necessary treatment merely by the threat of possible legal action.  However, a physician should respect the refusal of treatment from a patient who during the emergency situation is capable of providing consent.

Inside Right To Refuse Lifesaving Treatment