Chapter 3.A.1: The Competent Patient

The State's Interest in Preserving Life, note 2

While the Bergstedt court deferred to Mr. Bergstedt's assessment of his quality of life, even though his desire to stop treatment was based on concerns about potential future suffering rather than current suffering, the court did give greater weight to the state's interest in preserving life than have other state supreme courts. Instead of writing as in Conroy that a patient's right to refuse treatment is not affected by the patient's medical condition or prognosis, the court wrote that "the individual's right to decide will generally outweigh the State's interest in preserving life" when the (1) the patient is a competent adult, (2) the patient requires "artificial life support systems or some form of heroic, radical medical treatment," and (3) the patient is "enduring physical and mental pain and suffering." 801 P.2d at 624.  

There have not been subsequent Nevada Supreme Court cases indicating the extent to which Bergstedt limits a competent adults ability to refuse life-sustaining treatment. And the Cruzan Court did not settle the question since it assumed for purposes of the case that a competent patient has a right to refuse artificial nutrition and hydration.

The State's Interest in Preserving Life, note 4

In In re Duran, a 34 year-old mother of two teenage children needed a liver transplant. Before the transplant, the patient executed a durable power of attorney for health care in which she wrote

I am one of Jehovah's Witnesses. On the basis of my firmly held religious convictions, see Acts 15:28, 29, and on the basis of my desire to avoid the numerous hazards and complications of blood, I absolutely, unequivocally and resolutely refuse homologous blood (another person's blood) and stored autologous blood (my own stored blood) under any and all circumstances, no matter what my medical condition. This means no whole blood, no red cells, no white cells, no platelets, and no blood plasma no matter what the consequences. Even if health-care providers (doctors, nurses, etc.) believe that only blood transfusion therapy will preserve my life or health, I do not want it. Family, relatives or friends may disagree with my religious beliefs and with my wishes expressed herein. However, their disagreement is legally and ethically irrelevant because it is my subjective choice that controls. Any such disagreement should in no way be construed as creating ambiguity or doubt about the strength or substance of my wishes.

After the liver transplant, the patient did not do well, and her doctors recommended a blood transfusion to help prolong her life. The patient's husband obtained a court order for the transfusion, which was administered, even though the transfusion violated the patient's directions in her durable power of attorney and even though the husband was not the person appointed by the patient as her proxy under the durable power of attorney. (The patient died anyway a few weeks later.)

The superior court held that the court of common pleas had erred in granting the husband's request for a blood transfusion.

In another case involving refusal of blood transfusions by a Jehovah's Witness, Sherief Holston came into the hospital for the delivery of her third child and executed an advance directive rejecting blood transfusions. While Ms. Holston gave birth without the need for a blood transfusion, she suffered severe internal bleeding the next day following a tubal ligation. Six days later, with Ms. Holston in a medically-induced coma, her husband petitioned the court to order the transfusion of blood. The trial court judge held that the advance directive did not apply to the tubal ligation and ordered the transfusion. Ms. Holston recovered and left the hospital in good health. On appeal, the court dismissed the as moot. Holston v. Holston, 2009 WL 1586600 (N.J. Super. Ct. App. Div.).