Matter of Eichner, 52 N.Y.2d 363 (1981)

A competent adult has a common-law right to refuse medical treatment, even life-sustaining treatment, and this right can be exercised on their behalf if they have clearly and convincingly expressed their wishes prior to becoming incompetent.

Summary

These consolidated cases, Matter of Eichner and Matter of Storar, address the issue of whether life-sustaining medical treatment can be discontinued for incompetent patients. In Eichner, the court considered whether a religious brother’s prior statements about not wanting extraordinary life support should be honored. In Storar, the court examined whether blood transfusions should be continued for a profoundly retarded man with terminal cancer, against his mother’s wishes. The Court of Appeals held that Brother Fox’s prior expressed wishes should be respected, while John Storar’s lack of competency and the life-saving nature of the transfusions required that they continue.

Facts

In Eichner, Brother Fox, an 83-year-old member of a religious society, suffered cardiac arrest during hernia surgery, leaving him in a permanent vegetative state dependent on a respirator. Prior to the surgery, he had discussed the Karen Ann Quinlan case and stated he would not want “extraordinary business” done for him under similar circumstances. In Storar, John Storar, a 52-year-old profoundly retarded man with terminal bladder cancer, was receiving blood transfusions. His mother, his legal guardian, requested the transfusions be stopped because they caused him discomfort.

Procedural History

In Eichner, the Supreme Court granted the petition to remove the respirator, and the Appellate Division modified and affirmed, establishing procedures for such cases. In Storar, the Supreme Court denied the application to continue transfusions, and the Appellate Division affirmed. The Court of Appeals consolidated the appeals, but both patients died during the appeal process, rendering the specific controversies moot.

Issue(s)

1. Whether a competent adult has a right to decline medical treatment?

2. Whether that right can be exercised by another on the patient’s behalf if the patient becomes incompetent?

3. Whether blood transfusions can be discontinued for a profoundly retarded man with terminal cancer, when those transfusions are necessary to prolong his life?

Holding

1. Yes, because every person “of adult years and sound mind has a right to determine what should be done with his own body.”

2. Yes, because when there is “clear and convincing proof” that a person, now incompetent, left instructions to terminate life-sustaining procedures when there is no hope of recovery, those instructions should be honored.

3. No, because a parent may not deprive a child of lifesaving treatment, even if the child is an adult with profound retardation.

Court’s Reasoning

The Court reasoned that a competent adult’s right to refuse medical treatment is grounded in common law, as articulated in Schloendorff v. Society of N.Y. Hosp., noting that a surgeon who operates without consent commits assault. This right is not absolute, as the State has interests in protecting life, but there is no statute in New York that prohibits a patient from declining necessary medical treatment. When a patient is incompetent, the decision to discontinue treatment is more sensitive. If the patient had expressed their wishes prior to incompetency, those wishes should be honored, provided there is clear and convincing evidence of their intent. The court noted, “Clear and convincing proof should also be required in cases where it is claimed that a person, now incompetent, left instructions to terminate life sustaining procedures when there is no hope of recovery.” In Storar, the court emphasized that John Storar had never been competent, thus his mother’s wishes could not override the necessity of life-saving treatment. “A parent or guardian has a right to consent to medical treatment on behalf of an infant (Public Health Law, § 2504, subd 2). The parent, however, may not deprive a child of lifesaving treatment, however well intentioned”. The court distinguished the transfusions from the cancer itself: “the transfusions were analogous to food — they would not cure the cancer, but they could eliminate the risk of death from another treatable cause.”