The Clarence Herbert case: was withdrawal of treatment justified?

Abstract

Clarence Herbert, 55, stopped breathing following routine surgery in August 1981. Though a respirator restored his breathing, the lack of oxygen had caused severe brain damage, and Mr. Herbert was in a coma. Whether he could recover beyond a vegetative state was not known. Two days after her husband was placed on the respirator, Mrs. Herbert authorized the withdrawal of all life-support means. Mr. Herbert died six days later. Charges of murder by deprivation of treatment against the two attending physicians were dismissed in a lower court, a decision that was upheld in the state appeals court. Because court accounts are unclear, it is impossible to judge whether withdrawal of treatment was moral in this case. This case, however, raises a question about life-sustaining treatment in general. What is the moral criterion for withdrawal: quality of life or quality of treatment? The quality-of-life principle removes the obligation to take life-sustaining measures when a person's life does not or will not meet certain standards. Quality of treatment permits the withdrawal of even minimally burdensome treatment if it is considered useless. Though the California case appears to rest on these principles, withdrawing treatment from a person in a permanent coma, such as Mr. Herbert, implies that the quality of life is so low that life is not worth preserving, if the patient has no potential for conscious life, others have no duty to preserve it. This judgment may be acceptable in a terminal case when treatment truly is useless; however, withdrawing treatment that is useful in prolonging life cannot be justified.