Ethical and Professional Implications
The autonomy of a competent patient is an issue not often debated in medical ethics. Refusal of unwanted treatment is a basic right, likened to the common law of battery, available to all people capable of a competent choice. These fundamental rules of medical ethics entered a completely new forum as medical technology developed highly effective life-sustaining care during the 20th century. Several watershed cases elucidated these emerging issues in the 1960’s and 70’s, none more effectively than that of Karen Ann Quinlan. Fundamentally, this case established that a once-competent patient without the possibility of recovery could have their autonomy exercised by a surrogate in regard to the refusal of life-sustaining treatment. This decision had a profound effect on medical ethics, including treatment of incompetent patients in end-of-life situations, creation of advance directives, physician-assisted suicide (PAS) and active euthanasia.
By ruling in the favor of Mr. Quinlan, the New Jersey Supreme Court allowed for patient autonomy to be exercised by an incompetent patient. Though the legal implications of this decision vary from state to state, medical ethics now had to incorporate the possible refusal of a once competent patient unable to give that refusal. This concept is not one that was totally unexpected by the medical community. By developing machinery capable of sustaining life even in the case of severe deficit, it is only natural that medical ethics would need to adapt, growing to accommodate this new realm of consideration. Just as a competent person has the right to decide “how much to struggle, how much to suffer, how much bodily invasion to tolerate, and how much helplessness and indignity to endure,” (Cantor, N. Twenty Five Years After Quinlan) so too should this right include the incompetent patient. The case of Karen Ann Quinlan led to four basic approaches to this ethical problem; advance directives or other clear evidence of the patients wishes while competent, surrogate decision making (power of attorney), and action in the patients best interest. Each solution has deficiencies both in theory and practice, but there can be no debate that their application has changed the landscape of medical ethics.
The advance directive, or living will, is one way of circumventing the ethical dilemma of Quinlan, as it is essentially a set of choices by the competent patient if faced with different hypothetical circumstances. Patients can thus feel comfortable knowing that their competent wishes have been documented and can be easily interpreted in case of catastrophe. However, the authority of advance directives is a topic hotly debated amongst medical ethicists (see Advance Directive Authority). Arguments against directives state that not all factors are considered by the person creating the advance order. Also, in some cases of severe dementia, it is argued that...