I am just about ready to post almost verbatim excerpts from last Tuesday's oral argument in Betancourt. But I first wanted to make one general comment. The court seemed preoccupied (for obvious policy reasons, should they go on to decide the arguably moot matter) whether a decision in favor of plaintiff/appellee would be read as granting "unfettered" authority to the patient/surrogate.
Obviously, the patient's (or the surrogate's authority in effectuating the will of the patient) is not "unfettered." Rather, it might, in four instances be outweighed. Those classic instances are (1) the protection of life, (2) the prevention of suicide, (3) the protection of the rights of third parties and (4) safeguarding the integrity of the medical profession.
The New Jersey Supreme Court has noted that with respect to a patient's decision to terminate LSMT, three of the four above rights will always yield to the patient's right to self-determination. The only time that an individual patient's decision regarding termination of LSMT can be outweighed is when the rights of third parties will be directly affected by the patient's decision. Presumably that factor can also outweigh a patient's decision to continue treatment.
UPDATE: In my own argument, I noted that three notable "exit options" for healthcare providers include: (1) physiological futility, (2) transfer, and (3) guardian substitution in a case of proven abuse of authority/duty. These are vehicles through which providers can escape from a presumptive duty to comply with requests/demands for life-sustaining treatment. Sure, there may be yet additional "fetters" on patients' rights to demand treatment. But Appellants themselves describe the question in this case as presenting a "legal, moral, ethical, and medical" dilemma (Def/App brief at 25) This highlights that the question is not a purely medical one. Therefore, according to the New Jersey Supreme Court, while the input of physicians is useful, there is no reason to defer to their opinion.
UPDATE: In my own argument, I noted that three notable "exit options" for healthcare providers include: (1) physiological futility, (2) transfer, and (3) guardian substitution in a case of proven abuse of authority/duty. These are vehicles through which providers can escape from a presumptive duty to comply with requests/demands for life-sustaining treatment. Sure, there may be yet additional "fetters" on patients' rights to demand treatment. But Appellants themselves describe the question in this case as presenting a "legal, moral, ethical, and medical" dilemma (Def/App brief at 25) This highlights that the question is not a purely medical one. Therefore, according to the New Jersey Supreme Court, while the input of physicians is useful, there is no reason to defer to their opinion.