Posted on 03/19/2005 12:31:03 AM PST by bd476
Health Care Decisionmaking and Declarations in New York
"...In the case of artificial nutrition and hydration, the New York Department of Health issued a Memorandum (#89-84 dated 10-20-89, "Honoring a Patient's Wishes for Nutrition and Hydration") that makes it clear that the requirements of state law to provide suitable and sufficient nutrients for patients do not require a nursing home to provide a patient with such nutrients and fluids when there is clear and convincing evidence that the patient wishes to refuse such care and understands the consequences of such refusal. Said memorandum specifies the precautions and procedures to be followed to be followed in regard to either withholding or withdrawal of adequate nutrition and hydration, without distinction between what is required in either case.
Although New York has no statutory law regarding advance directives other than its Health Care Proxy law, discussed earlier, its courts have also consistently upheld the right of an adult without capacity to have medical treatment withheld or withdrawn when there is evidence that the individual made statements setting forth his or her intent in regard to treatment while he or she had capacity.
New York requires, under Matter of O'Connor, 72 NY2d 517 (1988), that the evidence of such intent be clear and convincing. It must indicate that the individual, if he or she now had capacity, would wish to forego this type of treatment, in his or her particular circumstances. The evidence must also be such as to demonstrate that this was a firmly held (not casual) decision. Under Cruzan v. Director, Missouri Dept. of Health, 497 US 26l, 111 L.Ed2d 224, (1990), the Supreme Court has said that a state can require that evidence meet such a standard.
Although the O'Connor court said that written evidence is best, the required evidence does not have to be in the form of a document executed by the patient but can be based upon oral statements made by the patient to others that indicate his or her desires. (see Matter of Eichner, supra.)
Where an incompetent patient has made no prior statements and has not appointed a health care agent (or was never competent) a facility must maintain and treat that patient in accordance with accepted medical standards (except for CPR if there is a valid DNR order in effect).
Under New York law, the appointment of an agent for legal affairs by a power of attorney does not (and cannot) give the agent the authority to make health care decisions. Family members also have no legal right to make such decisions for the patient in the absence of evidence of the patients previously expressed wishes although physicians and institutions have traditionally looked to them for decisions and may in some cases follow their wishes.
b>A Conservator for an individual has no right to make medical decisions although a Committee appointed for an incompetent patient may make medical decisions to authorize, but not withhold, treatment. [see Matter of Storar, 52 NY2d 363 (1981) (companion case to Matter of Eichner.]
As of April 1, 1993, New York has a new Guardianship law (replacing the prior Conservator and Committee laws) under which the Guardian may be granted full medical decision-making powers (other than the power to withhold or withdraw artificial nutrition and hydration absent evidence of the patient's previously expressed wishes in that regard).
New York courts have granted orders directing nursing homes and hospitals to remove feeding tubes based on a patient's prior statements while competent. Elbaum v. Grace Plaza of Great Neck, 148 AD2d 244 (2nd Dept 1989) involved an incompetent patient being fed with a feeding tube in a nursing home whom the court found had made sufficient statements while competent to constitute a firm and settled decision to refuse food and water. The court found that the patient's right to refuse treatment outweighed all asserted state interests, including the "perceived ethical integrity of Grace Plaza." In so finding, the court emphasized that the nursing home had failed to make its policy known to the patient prior to her admission..." and
Validity in Other States.
"Given the mobility of our society, it is extremely likely that an individual who executes a Health Care Declaration could be a resident of, or traveling through, another state at the time a medical decision had to be made. While it would, therefore, undoubtedly be desirable to have a national approach to this issue, such is not presently the case and we must be prepared to deal with the legislative or judicial solutions of the various states. In fact, in the Cruzan decision, while acknowledging that each competent individual has a constitutional liberty interest to be free of unwanted medical treatment, the Court left the issue of how to regulate this right for incompetent patients up to the states..."
and
"...Although the laws vary from state to state, most
- define the condition the patient must be in for either the health care declaration to become effective or the agent or surrogate to be empowered to make decisions on the patient's behalf,
- define the type of treatment that can be foregone,
- require certain certification procedures to ensure that the patient is in the requisite condition, and
- define who can serve as agent or have surrogate decision- making authority.
An individual may not wish to limit the circumstances under which medical treatment could be withdrawn or withheld to those provided in the law of the particular state in which he or she resides at the time of execution. For example, Florida law limits withdrawal of medical treatment to situations where the patient has a "terminal condition" and death is "imminent". As a result, language such as the following is found in many forms:
"If at any time I should have a terminal condition and if my attending physician has determined that there can be no recovery from such condition and that my death is imminent..."
A terminal condition is defined in Florida law as a condition caused by injury, disease or illness from which, to a reasonable degree of medical certainty, there can be no recovery and which makes death imminent. The word "imminent", however, is not defined in the law. A Florida resident who wished treatment terminated even when he or she was not imminently terminal might not wish to include such limiting language in his or her health care declaration. Such individual should, however, be made aware of any limitations contained in Florida law that may affect the degree to which his or her wishes will be followed.
An individual may also not wish to limit the treatment to be withdrawn or withheld to the specific kinds set forth in a particular state law. Florida, for example, again, limits the application of its law to what are called to "life-prolonging procedures" which are defined in the law as "any medical procedure, treatment or intervention that (a) utilizes mechanical or other artificial means to sustain, restore, or supplant a spontaneous vital function; (b) when applied to a patient in a terminal condition, serves only to prolong the process of dying".
That term could be more narrowly interpreted than the individual would wish and specifically does not include the provision of sustenance or the administration of medication or performance of any medical procedure deemed necessary to provide comfort care or alleviate pain but it does provide that sustenance can be included as a life-prolonging procedure where the patient has executed a declaration expressly authorizing the withholding of withdrawal of such, where the attending physician and one other physician document that sustenance in a life-prolonging procedure for that patient and that death is imminent, and where the patient's next- of-kin do not negate the decision to withhold or withdraw sustenance. Therefore, an individual who would want artificial nutrition and hydration withheld or withdrawn, should clearly say so and, in any case, it would be preferable not to rely on a term such as "life-prolonging procedure".
Clearly, it will be important that each individual give careful thought to these issues before executing any Health Care Declaration. It is important to make sure that his or her wishes are expressed in a way that is most likely to result in meeting the requirements of whatever state he or she is a resident or in which he or she may be receiving treatment at the time a decision has to be made so that his or her wishes will be honored, but without including language in the document limiting its application so it conforms to the requirements of the law of one particular state, if such restrictions are not what the individual desires.
Health Care Decisionmaking and Declarations in New York
And Greer, vilified by many religious protesters, is a church regular. He also is a conservative Republican in a state whose conservative Republican governor tried to overturn one of Greer's orders
Source: St. Petersburg Times
Greer is a Republican. So what? He is also a very Bad Man.
NY Law appears to be pretty much the same as FL Law on this issue. If the laws had been followed, Terri would never would have been in danger of being euthanized.
Not only is George W. Greer a registered Republican but so are Michael R. Schiavo and Jodi Centonze!
Also, Greer excommunicated himself from Calvary Baptist Church just a couple days ago.
http://www.freerepublic.com/focus/f-news/1365863/posts
groan...not you, too. Okay, so is the gist that each state has different laws? Yes. According to what state you're living in, make sure you've taken all the legal steps, and managed as much annotation as you can. I don't like it either! But just because she and her family got sickos for judges, and a bastard for a son-in-law, is no reason .... you know what, I give up on this.
"You've had a long day,"(from BigSkyFreeper)
We all have. And a long weekend. And it ain't over yet.
Maybe it would help if every poster on all the Terri threads took a second to take a breath, and realize that everyone is stressed, tired, and has concerns one way or the other and has the right to discuss and debate those issues.
Although we all have strong convictions, and tempers have flared, it is not because any of us are "BAD", or "EVIL". It is because we are all human.
Terri's case has brought forth a SUITCASE full of issues, which bred 'factions' during our discussions.
We have:
The Judicial Court Issue
The Euthanasia Issue
The State Law Issue
The Federal Law Issue
The Hospice Staff Issue
The Roman Catholic Church Issue
The women's hygiene Issue
The Money Issue
The Medicare Scam Issue
The Right to Life Issue
The Right to Die Issue
The Right to decide for others issue
The Right to have no decision issue
The Right to be tortured Issue
The PVS/Coma/Braindead Issue
The hearsay/heresay/whosay/Isay Issue
The gastronomy tube/Life Support Issue
The Heart Attack/Cardiac Arrest Issue
The Diet/Bulimia Issue
Terri Schiavo-Schindler
Judge Greer
Michael Schiavo
George Felos
George Bush
Jeb Bush
Dr. Gambone/Hammersfahr/Wolfson/etc.
The Schiavo Family
The Schindlers
Rush Limbaugh (how'd he get in here?)
The Florida Attorney General
The Pope
Moose
Cheese
(Help, someone stop him.)
The biggest problem we have is we all think we are talking about the same thing, and yet poster A seems to be discussing ISSUE X , with poster B who is discussing ISSUE Y.
It's remarkable that posters heads don't explode after a while.
"...Florida, for example, again, limits the application of its law to what are called to 'life-prolonging procedures' which are defined in the law as 'any medical procedure, treatment or intervention that (a) utilizes mechanical or other artificial means to sustain, restore, or supplant a spontaneous vital function; (b) when applied to a patient in a terminal condition, serves only to prolong the process of dying'.
That term could be more narrowly interpreted than the individual would wish and specifically does not include the provision of sustenance or the administration of medication or performance of any medical procedure deemed necessary to provide comfort care or alleviate pain but it does provide that sustenance can be included as a life-prolonging procedure where the patient has executed a declaration expressly authorizing the withholding of withdrawal of such, where the attending physician and one other physician document that sustenance in a life-prolonging procedure for that patient and that death is imminent, and where the patient's next- of-kin do not negate the decision to withhold or withdraw sustenance. Therefore, an individual who would want artificial nutrition and hydration withheld or withdrawn, should clearly say so and, in any case, it would be preferable not to rely on a term such as 'life-prolonging procedure'..."
? Hmmmm. :) I understand what you're trying to say, I think.
You're right. Bottom line is, everyone feels helpless. I really didn't join in these threads until conservatives began requiring the federal congress to "do something," and I'm just going to stay out of it after all. Emotions are running too high. Thanks for trying, with me at least.
There is a new proposed NY law, however, which may change all this.
Also, in my opinion, this presents good reason why it is a Federal issue. Post 221
Thanks for the ping, but I'll need coffee for that. Maybe tomorrow, if the cold improves.
Oh, sorry to hear about the cold. Get some rest. :)
Why are doctors even involved? I mean so what if she is brain-damaged or brain-dead? The judge has no right.
Is it within the power of the judge to order someone killed who has not commited a crime?
THINK!
This is nothing to do with Terri's medical condition. It is about judicial tyranny.
A judge is involved because it regards an issue within a law that the parties are addressing on both sides. A judge is called upon to make his/her best ruling as regards to his/her opinion of the law's meaning and scope. I think.
"Is it within the power of the judge to order someone killed who has not commited a crime?
THINK!
This is nothing to do with Terri's medical condition. It is about judicial tyranny."
======
Exactly!!!!
Discussing her medical condition is a red herring.
I agree, it doesn't matter what it is, if her parents want to take care of her and assume all responsibility, how can anyone kill Terri, instead of allowing her to live under the care of her loving parents?
As I said on another thread, if stray dogs are in an animal shelter and are going to be put to death, but someone adopts them, they are allowed to live under the care of those people. So why not allow Terri the same rights that are even given to stray animals?
Im sitting here completely dumbfounded watching all thing debate concerning her medical condition.
Its surreal, people a looking for reason or some justification to kill her.
No one has any "right" to kill her!!
Leave her alone and let her parents take care of her.
And as I said several times already on other threads, I think whether or not she is in PVS shouldn't even be the issue. The issue should be whether her husband, who has been living with another woman and has two children by her, and clearly has a conflict of interest with Terri's being kept alive, should be allowed to make life and death decisions for Terri. Especially, when Terri's parents are willing to assume all responsibility for her and care for her, whatever her condition is. Terri is not on "life support", as on breathing machine and so on, all she needs is food and water.
There are so many red herrings that people argue about, totally missing the main point, that in absence of written direction from Terri, they should err on the side of life, especially since her parents want to take care of her. How could the judge not rule for that defies imagination.
Okay, calm and collected.
I understand clearly your point and see its relevance.
My point however is that "no one" has a "right" to kill her regardless of their relationship with her or with any regards to her medical condition.
Case Closed! There is nothing to argue about!
Think!
Me and my wife have two boys - we want another baby but we want a girl - can a judge issue a court order that I must produce a male?
My wife does not like my cooking. Can Judge Greer issue an order saying that she has to like it?
Im not sure what God's plans are for me. Do I go to heaven or Hell. Can Judge Greer issue a court order that I go to heaven?
Sounds silly does it not?
It also sounds silly that a judge would issue an order to starve a woman to death.
It is not within his power to do so.
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