Case Problem: BIOETHICS COMMITTEE NOT CONVENED

In this medical malpractice suit, the Stolles (appellants) sought damages from physicians and hospitals (appellees) for disregard of their instructions not to use "heroic efforts" or artificial means to prolong the life of their child, Mariel, who was born with brain damage. The Stolles argued that such negligence resulted in further brain damage to Mariel, prolonged her life, and caused them extraordinary costs that will continue as long as the child lives. The Stolles had executed a written "Directive to Physicians" on behalf of Mariel in which they made known their desire that Mariel's life not be artificially prolonged under the circumstances provided in that directive. Mariel suffered a medical episode after regurgitating her food. An unnamed, unidentified nurse-clinician administered chest compressions for 30 to 60 seconds, and Mariel survived. The Stolles sued, alleging the following, among other things: Appropriate medical entries were not made in the medical record to reflect the Stolles' wishes that caregivers refrain from "heroic" life-sustaining measures. Lifesaving measures were initiated in violation of the physician's orders.

The hospital did not follow the physician's orders, which were in Mariel's medical chart, when chest compressions and mechanically administered breathing to artificially prolong Mariel's life were applied, and a bioethics committee meeting was not convened to consider the Stolles' wishes and the necessity of a do-not-resuscitate (DNR) order. The central issue in this case is whether appellees are immune from liability under the Texas Natural Death Act. Section 672.016(b) of the Texas Natural Death Act provides the following: "A physician, or a health professional acting under the direction of a physician, is not civilly or criminally liable for failing to effectuate a qualified patient's directive" [Tex. Health & Safety Code Ann. A4 672.016(b) (Vernon 1992)]. A "qualified patient" is a "patient with a terminal condition that has been diagnosed and certified in writing by the attending physician and one other physician who have personally examined the patient." A "terminal condition" is an "incurable condition caused by injury, disease, or illness that would produce death regardless of the application of lifesustaining procedures, according to reasonable medical judgment, and in which the application of life-sustaining procedures serves only to postpone the moment of the patient's death.

Mariel was not in a terminal condition, as appellees alleged. The Stolles failed to cite any authority that would have allowed the withdrawal of life-sustaining procedures in a lawful manner. The Texas Natural Death Act, therefore, provided immunity to the caregivers for their actions in the treatment and care of Mariel.

Ethical and Legal Issues

1. Describe the ethical principles in conflict in this case.

2. Do you agree with the court's decision? Explain your answer.