Chapter 5.A.1 (or 3.A.1) The Competent Patient
The Individual Interest in Refusing Treatment, note 7
For additional studies on the costs of care at the end of life, see Samuel S. Richardson, et al., Use of Aggressive Medical Treatments Near the End of Life: Differences between Patients with and without Dementia, 42 Health Serv. Res. 183 (2007) (concluding that “during the final 30 days of life, acute care patients with dementia are treated substantially less aggressively than patients without dementia”); Berhanu Alemayehu & Kenneth E Warner, The Lifetime Distribution of Health Care Costs, 39 Health Serv. Res. 627 (2004) (finding that nearly half of the lifetime spending for health care occurs after age 65 for the average person and for those who live at least 85 years, more than a third of their spending occurs after age 85).
The State's Interest in Preserving Life, note 4
In In re Duran, a 34 year-old mother of two teenage children needed a liver transplant. Before the transplant, the patient executed a durable power of attorney for health care in which she wrote
I am one of Jehovah's Witnesses. On the basis of my firmly held religious convictions, see Acts 15:28, 29, and on the basis of my desire to avoid the numerous hazards and complications of blood, I absolutely, unequivocally and resolutely refuse homologous blood (another person's blood) and stored autologous blood (my own stored blood) under any and all circumstances, no matter what my medical condition. This means no whole blood, no red cells, no white cells, no platelets, and no blood plasma no matter what the consequences. Even if health-care providers (doctors, nurses, etc.) believe that only blood transfusion therapy will preserve my life or health, I do not want it. Family, relatives or friends may disagree with my religious beliefs and with my wishes expressed herein. However, their disagreement is legally and ethically irrelevant because it is my subjective choice that controls. Any such disagreement should in no way be construed as creating ambiguity or doubt about the strength or substance of my wishes.
After the liver transplant, the patient did not do well, and her doctors recommended a blood transfusion to help prolong her life. The patient's husband obtained a court order for the transfusion, which was administered, even though the transfusion violated the patient's directions in her durable power of attorney and even though the husband was not the person appointed by the patient as her proxy under the durable power of attorney. (The patient died anyway a few weeks later.)
The superior court held that the court of common pleas had erred in granting the husband's request for a blood transfusion.
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