Two Orthodox groups back patient autonomy
NJ family sought life support for man in vegetative state
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September 23, 2009
In a case pitting patients’ rights against physicians’ decisions, two Orthodox groups filed an amicus brief advocating the right of a New Jersey man to receive medical care despite a hospital’s advice to discontinue life support.
The brief by Agudath Israel of America and the Rabbinical Council of America is one of five being submitted in the case, which is to be heard in the Superior Court of New Jersey, Appellate Division. A date has not yet been set.
At issue is whether the family of a patient in an irreversible vegetative state could continue care that physicians said was futile. It’s a recent twist on a more common, and more settled, medical and legal issue: whether the patient’s family has the right to “pull the plug” and discontinue care against the wishes of the medical establishment.
The Orthodox groups’ brief advocates the patient’s right to further treatment, following the Jewish legal principle that places the importance of life above all else.
“The organizations and their constituents, as a matter of deeply held religious conviction, believe that the decision to withdraw or withhold life-sustaining treatment from an incapacitated patient is a profoundly serious moral, ethical, and religious decision, and not, as the Appellant attempts to construe it, a purely medical decision,” reads the brief. “The organizations contend that physicians should not have the right to impose their ethical or moral views on a patient, in the face of clear wishes of the patient or his or her proxy to the contrary.”
Further, the brief states, to allow a physician to override the patient’s or patient’s family’s medical decisions “would eviscerate the patient’s right to self-determination.”
Mordechai Biser, associate general counsel for Agudath Israel, told NJJN in a telephone interview, “It’s an important case for the fundamental legal principle of who decides [on a course of action] when doctors think a patient should not continue to receive treatment. Is it the doctor’s decision or the patient’s and the family’s decision?”
“We felt as a matter of principle and as a matter of practicality,” said Biser, “that preserving the rights of our constituency was very important.”
‘A good decision’
The patient, Ruben Betancourt, 73, of Elizabeth, was admitted to Trinitas Regional Medical Center in Elizabeth for surgery in January 2008. Due to oxygen deprivation, he slipped into unconsciousness and was treated at a variety of hospitals before being readmitted to Trinitas in July 2008 with renal failure.
Betancourt was on an artificial ventilator, receiving dialysis, and being fed through a tube. Physicians, saying he was in an irreversible vegetative state, advised discontinuing mechanical life support treatment. The patient’s daughter, his legal guardian, sought a court order to force the hospital to continue treatment.
Judge John F. Malone of the Superior Court of New Jersey issued a decision in favor of the patient in March; the hospital appealed.
On the same day that the appeal was filed, Betancourt died. Nonetheless, the hospital plans to continue its appeal.
Agudath Israel has no relationship with the Betancourt family, who are not Jewish; Biser heard about the case through the public documents and publicity surrounding the case.
“We think the judge’s decision is a good decision,” he said. “We were surprised the hospital appealed and even more surprised they would continue the appeal after the patient died.”
Biser pointed out that as a matter of law, when families want to terminate treatment, established precedent is that patient autonomy prevails. “The law should be consistent. Patients cannot have the right to decline treatment but not have the right to continue treatment. Why should this be different?”
Arthur Caplan, director of the University of Pennsylvania’s Center for Bioethics, called this particular case “exceptional,” even under Jewish law.
He said because the patient was already determined to be dying, doctors should not have been required to continue treatment.
“This is a very rare situation in which the medical doctors and the family do not agree that life is preferable,” said Caplan. “Here, the doctors thought the patient was dying and it was hopeless.”
He pointed out that the doctors described the patient’s body as already beginning to decay.
Betancourt was “in the end-stages and the family wasn’t accepting that,” said Caplan. “We are not arguing about a disabled person; in that case, the family would get the nod. Betancourt was so far gone, nothing was going to happen except death,” he said.
Even under Jewish law, added Caplan, “We do not have to resuscitate someone whose heart stops 50 times. Sometimes, doctors do not have to honor the family’s wishes.”
The Orthodox Union was invited to join the brief but declined. Nathan Diamant, speaking to NJJN from his office in Washington, DC, said the organization had not had time to examine the issues in this case and was therefore not ready to take any position.
Trinitas did not return calls from NJJN.
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