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Quiz

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Test Yourself on Patients’ Rights

The following fact situations involve patients long resident in New Jersey. In each case, except if otherwise clearly indicated, the patient has full decision-making capability. Read each question carefully, and then click on your answer.

Susan is 58. She has just had extensive diagnostic tests. Her physician advises that she has a serious form of cancer, but that certain treatments may well extend her life to 10 or more years. Without any treatment he estimates she’ll live from 2 to 2-1/2 years. The doctor explains side effects and alternative therapies. Susan talks with her husband and children. She tells the doctor she will not undergo the treatment on account of the side effects. She only wants comfort care, she states. Does Susan have the right to reject treatment even if—as here—that will bring on her death much sooner?
  Yes—in all cases.
  Yes—but in only some cases.
  No.
The doctor talks further with Susan and her husband and persuades her to undergo treatment. At one point it becomes necessary to install a feeding tube and intravenous administration of fluids. Susan consents to this, but after a while changes her mind. She directs that the artificial administration of fluids and food be ended. The doctor warns her and her husband that without them she will lapse into a coma and probably die in a week or so. She persists in her demand that the tubes be taken out. Does Susan have the right to have the tubes removed even if—as here—that will cause her death?
  Yes—in all cases.
  Yes—but in only some cases.
  No.
Assume the previous facts are somewhat different. Susan has lapsed into a coma with the tubes in place. Her husband, Harold, is her duly appointed agent for medical decisions. He consults fully with the physician and decides that Susan would want the tubes removed were she awake. He talks with their two children. Sadly, they all concur, that "mom" would want the tubes taken out. Harold directs the physician to remove the tubes, although he well realizes this will cause his wife’s death in a week or so. Does Harold have the right to do this—must doctor and hospital comply?
  Yes—in all cases.
  Yes—but in only some cases.
  No.
George is 53 and suffering from terminal AIDS. He has duly written a Living Will that directs that no "heroic measures" be used to prolong his life in the event he is unable to participate in decision-making as to his medical care. The Living Will explicitly states that no feeding tubes or artificial administration of fluids are to be used. The hospital and his physician both have copies of the Living Will, and it is noted on his "chart". George lapses into a coma, and the hospital, notwithstanding his Living Will, inserts a feeding tube and begins intravenous administration of fluids. May the hospital lawfully do this in order to continue his life?
  Yes—in all cases.
  Yes—but in only some cases.
  No.
George’s long-time companion, Robert, comes to visit and is deeply relieved to find the hospital has disregarded George’s Living Will in order to continue his life. Robert directs the hospital to continue with the artificial administration of fluids and food. May Robert lawfully countermand the Living Will?
  Yes—in all cases.
  Yes—but in only some cases.
  No.
George’s parents come to visit. In writing they concur in what the hospital has done. Is this agreement by the parents sufficient to justify the hospital’s actions?
  Yes—in all cases.
  Yes—but in only some cases.
  No.
Martha is 78. She is suffering from advanced diabetes and has a seriously gangrenous right leg. Her physician tells her that unless the leg is amputated she will die. She replies: "If I can’t dance I don’t want to live. The leg stays." Is Martha entitled to reject the necessary life-saving treatment?
  Yes—in all cases.
  Yes—but in only some cases.
  No.
Martha lapses into a coma. She has difficulty breathing, so a ventilator (a machine that breathes "for" one) is installed. Her niece, who is her duly appointed agent for medical decisions, comes to visit and is horrified at this. She directs that the ventilator be turned off. The advance directive appointing the niece is on file with the hospital and noted on the chart. The physician protests that Martha can’t breathe on her own and will die if that were done. The niece persists in directing that the ventilator be turned off, arguing that she well knows this is what Martha would want. Must the hospital follow the niece’s direction although this will kill Martha?
  Yes—in all cases.
  Yes—but in only some cases.
  No.
Betty is 72 and suffering from terminal cancer with only five months of life expected. Her disease involves, among other organs, her spine. The pain is excruciating, and even with topflight pain treatment she cannot get relief from pain and any reasonable amount of sleep. She says to her physician: "Please, doctor, isn’t there something you can do to end this pain—even if it speeds up my dying?" The doctor says that in a case such as hers he can put her into an artificially induced coma or "sleep" with barbiturates and morphine, then increase the dosages. Eventually, says the doctor, breathing would be suppressed and death would occur. Any artificial feeding and fluids would be terminated. The doctor states that his intention would not be to cause her death, but rather to relieve her pain and suffering. Death would be the unhappy but inescapable side effect of this terminal sedation. Betty directs the physician to proceed with the terminal sedation. Is this lawful?
  Yes—in all cases.
  Yes—but in only some cases.
  No.
Same facts as the previous, except Betty responds: "Doctor, if you can do that, would it not be simpler and more humane simply to give me a massive injection of morphine and end my life that way?" May the doctor lawfully give such an injection.
  Yes—in all cases.
  Yes—but in only some cases.
  No.
Same facts as the previous, except that Betty is a long-time resident of Oregon and is hospitalized there. May the doctor lawfully give such an injection in Oregon?
  Yes—in all cases.
  Yes—but in only some cases.
  No.
Same facts as the previous. Betty asks her physician to write a prescription for a lethal dose of drugs which she may (or may not) later elect to use to end her suffering through death. May the doctor write such prescription?
  Yes—in all cases.
  Yes—but in only some cases.
  No.
Same facts as the previous. Betty’s doctor says that on account of his religious (or moral) beliefs he will not write such a prescription. Is it lawful for him thus to refuse this help?
  Yes—in all cases.
  Yes—but in only some cases.
  No.
Same facts as the previous except that Betty is a long-time resident of New Jersey and in New Jersey now. May the doctor write such prescription?
  Yes—in all cases.
  Yes—but in only some cases.
  No.
John is 45 and in mid-stage ALS ("Lou Gehrig’s disease"), which is invariably fatal. He probably has another 4 or 5 years of increasingly painful life ahead. He decides he will not further take food or water and communicates this decision to the nursing home where he resides. They honor his decision and provide low-grade pain relief, moisten his lips to prevent chapping, etc. In two weeks he peacefully dies. Was John’s decision lawful? Was the nursing home right to go along with it?
  Yes—in all cases.
  Yes—but in only some cases.
  No.
Same facts as the previous except that John is 65 and on Medicare. Is he entitled to the hospice benefit under Medicare if he wishes that option?
  Yes—in all cases.
  Yes—but in only some cases.
  No.
Same facts as the previous, except that John is admitted to an in-patient hospice program. He requests terminal sedation during the course of his dying. Is the hospice program obliged at law to provide terminal sedation?
  Yes—in all cases.
  Yes—but in only some cases.
  No.
Same facts as the previous. Whether rightly or wrongly the hospice refuses to give terminal sedation. John then demands to be discharged to his home. A friend and 24-hour nursing will be available. He states that he will get some physician to give the terminal sedation there. In the context of his announced intention to "kill himself" (not John’s characterization but the hospice’s) the hospice refuses to discharge him. May they legally do so?
  Yes—in all cases.
  Yes—but in only some cases.
  No.
Same facts as the previous. John’s attorney intervenes and the hospice program eventually discharges him to his home. John asks his physician for terminal sedation. May the doctor give it?
  Yes—in all cases.
  Yes—but in only some cases.
  No.
Andrew is 58 and suffering from cancer in the terminal (less than six months to expected death) stage. As with Betty in question 9 the best pain relief care cannot give him adequate pain relief. He asks his physician for 30 Nembutal in order to be able to sleep. Unbeknownst to the physician Andrew secretly hoards the pills, then in a month asks for a further month’s supply. And he does that yet a third time. The doctor (who is reasonably knowledgeable in mental health matters) questions him on his state of mind and is persuaded he is not suicidal or depressed. With 90 Nembutal in hand Andrew asks his family and a few friends to gather for his "self deliverance"—at which time he proposes to take the powder from the pills in a little applesauce and expire. Is it lawful for his friends and family simply to be present to give moral and spiritual support while Andrew effects his "self-deliverance"?
  Yes—in all cases.
  Yes—but in only some cases.
  No.

NOTE: The foregoing scenarios were stimulated by—but in no sense based upon—those in Silveira, DiPiero, Gerrity and Feudtner, "Patients’ Knowledge of Options at the End of Life", Journal of the American Medical Association, Nov. 15, 2000, Vol. 284, No. 19, pp. 2483-88. The four M.D. authors did a study of 728 Oregon patients at four clinics. The conclusion was that even in Oregon, where assumedly there would be a somewhat higher level of knowledge on account of its two Death with Dignity Act initiatives and much public discussion of end-of-life issues, well less than half of patients were really knowledgeable as to their end-of-life rights. By way of example, only 23% knew of their rights under the Death with Dignity Act. Unknown rights at the practical level are no rights at all. And in this context of widespread ignorance, hospitals, physicians and nurses can practice the old "doctor knows best" care, ignoring the patient’s rights.

This quiz was developed by Winthrop Thies, former president of The Hemlock Society of New Jersey (the predecessor organization to Compassion and Choices of New Jersey, Inc.).