Section II: LIMITS ON THE RIGHT TO REFUSE
2-11. STATE INTERESTS
There are four state interests that have been recognized by courts throughout the
country. These state interests may outweigh the individual's right to autonomy in health
care decision-making, and thus, the patient's right to refuse treatment. (See chart
STATE INTERESTS THAT MAY OUTWEIGH A PATIENT'S RIGHT TO REFUSE
1. Preserving the sanctity of all life.
Particular patients involved in a given action (especially patients with life-
threatening conditions, minors, and dependents).
2. Protecting innocent third parties who may be adversely affected by the death of a
party seeking relief.
3. Preventing suicide.
4. Preserving the integrity of the medical profession.
NEW STATE INTEREST
5. "Encouraging the charitable and humane care of those whose lives may be
artificially extended under conditions which have the prospect of providing at least a
modicum of quality living."*
*Nevada Supreme Court decision (1991), binding in Nevada; could affect other courts
faced with similar situations.
2-12. THE SANCTITY OF LIFE: PATIENT AUTONOMY OVER STATE INTERESTS
a. Incompetent Patient Who Is Terminally III or Irreversibly Comatose. The
sanctity of life is the most basic of the state interests. It overrides the right to refuse
medical care in a number of cases. However, the principle of autonomy, also a basic
concept of health care ethics in the United States (US), has led courts to recognize
wishes expressed in living wills and other advance directives for patients who are
incompetent and terminally ill, or irreversibly comatose (in a persistent vegetative state).