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Who “Pulls the Plug:” The Practical Effect of the Saikewicz Decision

Published online by Cambridge University Press:  01 January 2021

Lee J. Dunn Jr.
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Extract

As general counsel to one of the largest hospitals in the United States, I want to discuss a topic which affects 15 to 20 patients in our hospital every day, those on whom physicians have written what we call “DNR” orders (Do Not Resuscitate). Any large tertiary care hospital has to deal regularly with this problem with respect to patients who are terminally ill and how to treat such patients in a wide variety of circumstances. What are the physician's and the hospital's obligations to provide Care?

On November 28,1977, the Massachusetts Supreme Judicial Court handed down its opinion in a case that has caused tremendous repercussions in hospitals throughout the country regarding the withholding or withdrawal of life-support to terminally ill patients. At the time this opinion was handed down, the decisions of physicians and hospitals on what to do with respect to withdrawing such care were based primarily on one of four models.

Type
Article
Information
Medicolegal News , Volume 6 , Issue 4 , Winter 1978 , pp. 6 - 8
Copyright
Copyright © American Society of Law, Medicine and Ethics 1978

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References

Superintendent of Belchertown State School v. Saikewicz, 370 N.E.2d 417 (Mass. 1977).Google Scholar
See In the Matter of Karen Quinlan, 70 N.J. 10, 355 A.2d 647 (1976).Google Scholar
Rabin, M. Gillerman, S. Rice, N., Orders Not to resuscitate, New England Journal of Medicine 295:364 (1976).CrossRefGoogle Scholar
For a more in-depth analysis of the Saikewicz decision, see Annas, G.J., Judges At the Bedside: The Case of Joseph Saikewicz, Medicolegal News 6(1):10 (Spring 1978).CrossRefGoogle ScholarPubMed
The words “best interest” were those of the court, see 370 N.E.2d at 433; however, the court specifically rejected the adoption of a “best interest” test earlier in its opinion, holding that a “substituted judgment” test was the proper method by which the court would ascertain the incompetent's actual interests, see 370 N.E.2D at 431.Google Scholar
370 N.E.2d at 433.Google Scholar
370 N.E.2d at 435.Google Scholar
For a discussion of these issues, see Raible, J., The Right to Refuse Treatment and Natural Death Legislation, Medicolegal News 5(4):6–8 (Fall 1977).CrossRefGoogle ScholarPubMed
For a discussion of the initial decisions by the probate Courts, see Annas, G.J., No Fault Death: After Saikewicz, Hastings Center Report 8(3):16 (June 1978).Google ScholarPubMed
Custody of Minor, 1978 Mass. App. Adv. Sheets 2002, July 10, 1978.Google Scholar
Lane v. Candura, 376 N.E.2d 1232, 1235–36 (Mass. App. 1978). Editor's Note: See companion article, by Glantz, Leonard, Post-Saikewicz: Judicial Actions Clarify the Rights of Patients and Families, Medicolegal News 6(4):00 (Winter 1978).CrossRefGoogle ScholarPubMed
In the Matter of Shirley Dinnerstein, 380 N.E.2d 134 (Mass. App. 1978).Google Scholar