In re matter of Dubreuil
i.        Woman needed blood transfusions.  She did not want them for religious reasons.
ii.        After surgery, she needed more blood and they went to the court to see if they could get an order to give her the blood.
iii.        The court did a balancing test:
1.        Weigh her personal rights v. detriment to the state.
2.        The state would not tolerate her abandoning her kids by allowing her own death to occur.
iv.        The Supreme Court said that her autonomy should be respected here, since there was a father to take care of the children.
v.        How would the court have ruled if there had not been a father to take care of them?
1.        They may have not respected her autonomy, since they leave this open.
2.        Here, their decision is very narrow to the facts.
vi.        This is a problem in medicine when the question of honoring the wishes of somebody or treating them properly arises.
vii.        It is rare that the court goes against the physician.
viii.        There comes a time when the right of refusal will result in the death of the patient.  A large body of law has come about with regards to the right to die.
1.        Originally, the problem was when patient with no brain function was placed on a respirator to be kept alive.  The patient was in a persistent vegetative state, which is a type of coma.
2.        From a legal standpoint, the question is whether these people have pain and suffering.  A lot of insurance issues fall into this category-can a patient collect for pain and suffering if they cannot perceive it.
3.        What if this person is going to be in this state forever?  How do you take them off the respirators and let them die?
a.        A definition of death, not including cardiovascular death, has arisen that is brain death.  Basically, they are brain dead by law if they have lost all useful brain function.
b.        Brain death is legally a condition where the patient is dead.
c.        What happens if the patient is brain dead, but can still spontaneously breathe?  The question is when you stop feeding them, medicating them and who makes those decisions.
4.        There are two legal standards:
a.        Based upon information from family and friends, the court determines what is in the best interest of the patient.
b.        The substituted judgment standard makes another’s judgment substitute for that of the patient.