Jehovah's Witness case highlights decision-making rights
By Katherine B. Kravitz
A Pennsylvania appeals court recently confirmed that the clear wishes of a competent individual as stated in a healthcare power of attorney should be given great deference, even, in some cases, over the objections of a spouse.
Marie Duran, a 34-year-old Jehovah's Witness and mother of two teenagers, who was suffering from advanced liver disease, underwent a liver transplant at the University of Pittsburgh Medical Center. Duran chose the hospital because she had been told that it had previously performed liver transplants on Jehovah's Witnesses without the need for blood transfusions. As a Jehovah's Witness, Duran strictly adhered to a biblical mandate to abstain from blood products and blood transfusions. Duran also executed a "durable power of attorney for medical care" in which she explicitly stated her wishes, including her desire not to receive blood or blood products even if her family and friends disagreed, and even if her healthcare provider said it was the only way to save her life or health. She also named Larry M. Johnson, a Jehovah's Witness, as her "agent" in the document.
Duran's body rejected the donor liver and a second liver was transplanted, which was also rejected. With Duran in a coma, her doctors said she would likely die within 24 hours without a blood transfusion. Duran's husband, who was not a Jehovah's Witness, petitioned the court to be appointed guardian so that he could consent to the transfusion. Johnson, Duran's appointed "agent", was not notified of the emergency proceedings. Duran's husband was appointed emergency guardian. Although Duran then received the transfusion, she died.
After her death, Johnson brought an appeal on the basis that the issues raised were of importance to all of the approximately 2 million Jehovah's Witnesses living in the U.S. The Appellate Court agreed to hear the issue. The court affirmed that a patient's right to withdraw consent to treatment, once begun, was the "logical corollary" to the well-established right of an individual to "control of his own person." The court acknowledged, however, that this right must be balanced against the state's interest in the: 1) protection of third parties; 2) protection of the integrity of the medical profession; 3) preservation of life; and 4) prevention of suicide.
Regarding third parties, the court noted that the primary focus was to determine whether the patient had dependents who would be left emotionally and financially bereft if the patient's wishes were carried out. The court found no evidence of this, and noted that it was well within the parameters of medical ethics to abide by a patient's direction to abstain from medical treatment under certain circumstances: "Medical ethics do not require medical intervention in disease at all costs." With regard to the preservation of life, the court noted that the State's interests were relatively low when the acts of one individual did not injure others or impact the public at large. Finally, the court confirmed that declining life-sustaining medical treatment could not be viewed as an attempt to commit suicide. Clearly this analysis weighed heavily in favor of the patient's right to self determination.
The court also distinguished Duran from another Jehovah's Witness blood transfusion case, In re Estate of Dorone. There the Pennsylvania Supreme Court affirmed a lower court decision allowing the appointment of a guardian to consent to a blood transfusion on behalf of a Jehovah's Witness despite the existence of a medic alert card identifying him as such. The court noted that Duran had provided a number of sources of information indicating her clear desire not to receive blood products and transfusions. This was enough to distinguish the case from Dorone.
The court said that Johnson should have been apprised of the emergency guardianship proceedings, and that he, not Duran's husband, should have been appointed as the guardian. However, the court noted that a guardian was, in fact, not needed at all, and that Duran's unequivocal directions should have been followed. "To hold differently would devitalize personal healthcare directives and devalue the common law right to personal autonomy."
Interestingly, the court did not focus on whether the power of attorney had been properly executed or was within the purview of the state power of attorney law, as some other courts have, instead focusing on the patient's clearly expressed intent.
Pennsylvania has a large Jehovah's Witness population, and this case should give healthcare providers some comfort when complying with the clearly expressed wishes of an adult Jehovah's Witness. Please note, however, that cases where the individual's intent is not so clear, and cases involving minor children of Jehovah's Witnesses, must still be closely scrutinized as the analysis obviously differs. More importantly, the case arguably has implications beyond scenarios involving Jehovah's Witnesses, and should offer hospitals and other healthcare providers guidance for resolving disputes arising in this area.
http://www.barley.com/pubs/health_0501.cfm#7
Yakki Da
Kent
"The only difference between a fool and the JW legal department is that a fool might be sympathetic ."
Daily News On The Watchtower and the Jehovah's Witnesses:
http://watchtower.observer.org