MAY 1, 2000 VOLUME 7, NUMBER 44
It has taken three decades to establish, but the notion of patient self-determination is now firmly entrenched in American law. A patient has the right to instruct that life-sustaining medical care be withheld or removed. To protect against future treatment, an individual can execute a living will and/or a health care power of attorney directing that care be withdrawn or withheld in future circumstances. But what happens when care providers treat the patient despite advance directives and against surrogates’ instructions?
Rebecca Jane Taylor was paralyzed on her left side and confined to a wheelchair after a stroke in 1992. She sought to prevent continued life support if she became terminally ill with no reasonable possibility of recovery. She gave her son Steven a health care power of attorney, and she even signed a form directing that a “do not resuscitate” order be placed on her chart at the Woodlands nursing home in Indiana.
In 1995, when Ms. Taylor suffered a second stroke and became comatose, her three sons met, discussed the situation and agreed. Steven Taylor signed the forms directing that his mother receive only intravenous fluids and that no tube feeding be instituted.
Two weeks later Ms. Taylor seemed to be responding to painful stimuli. Her attending physician directed that a nasogastric tube be inserted to provide both food and fluids, and the nursing home tried to contact Ms. Taylor’s sons.
Steven Taylor was at work that morning, and his wife promised he would get back to the nurse shortly. Rather than wait for Steven, the nurse called another one of Ms. Taylor’s sons, told him that his mother’s veins were collapsing and that she would die a terrible “dry death,” and got his consent. Shortly thereafter Steven Taylor contacted the nursing home and refused permission for the nasogastric tube. The attending physician decided he would break the apparent tie and instructed that the tube be inserted.
After Steven Taylor replaced the attending physician (and after the second physician increased Ms. Taylor’s tube feeding without informing family members), Ms. Taylor was moved to another facility. She died peacefully there ten days later, but five months after the Woodlands first violated Steven Taylor’s instructions as agent for his mother.
After her death Ms. Taylor’s estate brought a suit against the Woodlands for “wrongful prolongation of life.” The nursing home asked for dismissal of the suit, arguing that there is no such cause of action. The Indiana Court of Appeals agreed, insisting that Indiana law gave the Taylors their only remedy—they could have gone to court before their mother’s death to order the facility to comply with their instructions, but there was no claim for damages after her death. Estate of Taylor v. Muncie Medical Investors, April 20, 2000.