Читать книгу American Democracy in Context - Joseph A. Pika - Страница 152

Courts have long recognized a common-law right of individuals to refuse most unwanted medical procedures. But does the right of privacy also extend a broader constitutional right—one that includes a right to die? May patients refuse invasive procedures that would extend their lives, such as the use of an artificial respirator, on privacy grounds? The issue is complicated because such patients are often incapacitated and are not able to express their wishes. Moreover, they may have left no written instructions, such as a living will. Can the patient’s guardian make a substituted judgment for the patient in such a situation? This question is especially controversial because refusal of treatment under these circumstances often leads directly to the death of the patient.

Guardians sometimes argue that their loved one would not want to be kept alive with no hope of meaningful recovery—if, for example, the patient were brain dead. They offer the legal argument that forcing artificial life support on patients violates a fundamental right of privacy. But others argue that decisions to withdraw life support violate the patient’s right to life and may even constitute murder.

The Supreme Court first confronted the right to die issue in Cruzan v. Director, Missouri Department of Health (1990).¹⁰⁹ As in Roe v. Wade, the Court balanced competing interests. The majority noted that patients have a constitutionally protected right to refuse medical treatment but argued that such a right must be balanced against the interests of states (such as their interest in protecting life). Thus, the Court upheld a Missouri law requiring “clear and convincing” evidence that a patient would want life support refused before granting a guardian’s request to discontinue it. Seven years later, the Court ruled that a patient’s privacy right does not include a constitutional right to commit suicide. Individual states are the ultimate arbiters of such decisions. By January 2019, seven states plus the District of Columbia chose to allow doctor-assisted suicide, either through legislation or court ruling.¹¹⁰ Assisted suicide is legal in Germany and Switzerland, but some countries go even further. Active euthanasia is legal in Belgium, Canada, Colombia, Luxembourg, and the Netherlands.¹¹¹