Brief Fact Summary. A.C. was diagnosed with inoperable cancer while pregnant. Her condition worsened until she was unable to adequately communicate, and a hearing was held to determine if a caesarean section should be performed, during which there was conflicting testimony as to if A.C. would have consented to the operation.
Synopsis of Rule of Law. The procedure of substituted judgment must be used to ascertain the wishes of an incompetent patient to submit to treatment unless there are truly extraordinary or compelling reasons for overriding the patient’s wishes.
It is a right subject to at least four countervailing State interests: (1) the preservation of life; (2) the protection of interests of innocent third parties; (3) the prevention of suicide; and (4) the maintenance of the ethical integrity of the medical profession.View Full Point of Law
Issue. Who has the right to decide the course of medical treatment for a patient near death and pregnant with a viable fetus?
If the patient cannot make the decision for herself, how should the decision be made?
Held. The trial court erred by proceeding to a balancing analysis between the rights of A.C. versus the state without first finding a competent refusal by A.C. to go forward with surgery or without finding through substituted judgment that she would not have consented to surgery.
Any competent person has the right to accept or forego medical treatment. Likewise, the courts do not force a person to permit a significant intrusion upon their body for the benefit of another’s health.
First a court must determine if a patient is competent to make her own medical decisions, attempting to speak to the patient to ascertain her witnesses directly whenever feasible.
If the patient is incompetent to make a determination, the court must use the substituted judgment procedure, placing itself in the position of the incompetent and acting upon the same considerations and motives that would have moved her. Generally due process would suggest that an attorney or guardian ad litem should be appointed for the patient in this scenario. Greatest weight should be given to the previously expressed wishes of the patient, while a probing of the patient’s value system and determining what most persons would likely do also aiding the court.
Dissent. Substantial weight should be given to the rights of the viable unborn child. If the court determines that the patient would probably opt against a caesarean section, the court should vary the weight given this factor in proportion to the confidence the court has in the accuracy of its conclusion. The child’s interest in being born with the least degree of impairment should also be considered.
Discussion. The majority notes that family will often be the best source to determine the patient’s value system, but expresses concern that sometimes family members may rely on their own judgments or predilections rather than those of the patient.