SUBJECTIVE (SUBSTITUTED JUDGMENT) STANDARD APPLIED: PREVIOUSLY
COMPETENT PATIENT'S WISHES HONORED
In re Storar (N.Y. 1981), the subjective (substituted judgment) standard was applied.
The court upheld the right of the previously competent but now comatose patient,
Brother Fox, to refuse treatment based on an oral statement he had made to his
religious brethren. Shortly before suffering a cardiac arrest, becoming comatose, and
being placed on a respirator, he had told his brethren that he would not want to be kept
alive by "extraordinary means," were he to become like Karen Ann Quinlan (irreversibly
comatose but kept alive by a respirator). The New York State Court of Appeals
authorized removal of the respirator, since they considered his oral statement to be
"clear and convincing" evidence of his prior wishes.
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OBJECTIVE BEST INTERESTS STANDARD APPLIED: RIGHTS TO REFUSE
DENIED NEVER COMPETENT PATIENT
The same court* denied a never competent patient the right to refuse treatment because
his wishes could not be determined. In the absence of expressed wishes, the objective
standard had to be applied. John Storar, a 52-year-old man who was profoundly
retarded (with a mental age of about 18 months) was suffering from terminal cancer of
the bladder. His legal guardian and mother had consented to radiation treatments for
him and, after internal bleeding had begun, regular blood transfusions. She then
requested that her son's transfusions he terminated, because he was suffering from both
the pain of his cancer and the discomfort of being tied down for transfusions. And, it
was estimated that the transfusions would only add 3 to 6 months to his life. Unlike a
respirator, which is considered "extraordinary" treatment, blood transfusions are viewed
as routine (as basic as food itself). Unlike Brother Fox, Storar had never been
competent. The court ruled that since the patient was mentally an infant, he should be
given the same protections as a minor whose guardian seeks to refuse life-saving
transfusions. The decision, which seems cruel, was well-intentioned in that it sought to
protect a patient, who could not speak for himself, from relatives acting contrary to what
was believed to be the patient's best interests.
The court decided both Brother Fox's and John Storar's cases in an opinion entitled re
Storar.
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