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November 19, 1982

Withholding of Life-Sustaining Treatment From the Terminally III, Incompetent Patient: Who Decides?Part II

JAMA. 1982;248(19):2431-2432. doi:10.1001/jama.1982.03330190015006

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Part I of this article traced the early development of the law regarding decisions to discontinue potentially life-prolonging treatment of terminally ill patients (1982; 248:2250). In the seminal case of In re Quinlan, 355 A2d 647 (NJ 1976), the New Jersey Supreme Court held that a patient's constitutional right of privacy includes the right to refuse treatment where such treatment can only perpetuate a comatose, vegetative existence. Furthermore, this privacy right may be exercised on the incompetent patient's behalf by the guardian, family, and attending physicians, with the approval of the ethics committee of the hospital involved.

Subsequent decisions in other jurisdictions have endorsed Quinlan's constitutional rights analysis and have adopted, in principle, the concept of "substituted judgment." Many courts have rejected Quinlan's formula for private decision making, however, opting instead to delineate guidelines for determining when judicial approval is required to implement nontreatment decisions. Superintendent of Belchertown State School