Bucilla Stephenson’s Advance Directive for Health Care

The New York Times has an interesting article synthesizing some of Thaddeus Pope's research on a growing body of case law awarding damages for institutional or individual disregard of an advance directive for health care. 

The Georgia Supreme Court's July, 2016 opinion in the matter concerning the last two weeks of  the  late Bucilla  Stephenson's life and, in particular, the decision of Doctors Hospital of Augusta and Ms. Stephenson's ICU physician, to disregard her advance directive for health care and to intubate her first and ask questions later is worth a careful read.  The ICU doctor saw the decision as one that could be easily reversed and decided to err on the side of life continuation.  The family saw the decision as one not easily reversed — distinguishing between a scenario where Bucilla Stephenson would be allowed to die and another (affirmatively acting to remove the intubation, as was eventually done) involving causing her to die.

My students are often inexperienced with life and death decision making. Many of them struggle to understand the philosophical and ethical distinction some others draw between action and inaction in end of life matters.  This is, however, a very old distinction.

Ms. Stephenson and her family may be caught between two world views: those that draw the action/omission line and those who see reversible action as a kind of benign buying of decision making time. I will note that Doctors Hospital of Augusta ICU doctors did themselves no favor by both intubating without the specified consultation with Ms. Stephenson's advance directive for health care decision making power holder and then not contacting that granddaughter to notify her of what they had done, leaving the granddaughter and her husband to discover the intubation and ventilator use at an ordinary family visit four hours later.