10
quality of life, the state would not require amputation in the event it should become
necessary.
Both of the above cases were heard in Pennsylvania courts. In deciding the Fiori
case, the state recognized and upheld the right of an individual to refuse medical
treatment. This right "has deep roots in our common law" (In Re: Daniel Joseph Fiori
1995, 6), but it is not absolute. The interests of the state must balance patient rights.
Pennsylvania has four such interests: (1) protection of third parties (e.g., would any
dependents be injured by the decision?), (2) prevention of suicide, (3) protection of the
integrity of the medical community, and (4) preservation of life. These concerns are
reflected in the commonwealth's advance directives statute, in which a patient's wishes
become "operative" only in the event of a terminal illness (less than six months to live, as
substantiated by two physicians) or permanent unconsciousness (Advance Directive for
Health Care Act, 1992).
When considering his mother's request, it became clear to the court that since
Daniel had no dependents, there would be no injury to third parties. Likewise suicide
was not an issue because the injuries were not self-inflicted. The ethical integrity of the
medical community would also be upheld, based on statements made by the Pennsylvania
Medical Society.
4
The focus in this case was on the state's interest in preserving life. It
was decided that the interest in preserving the life of someone in a PVS is "so weak that it
cannot overcome the individual's right to self-determination" (In Re: Fiori 1995, 8).
4
In a brief presented to the Superior Court, the Pennsylvania Medical Society stated that "withdrawal of
life-support from Fiori would not compromise medical ethical principles," since in their view there was no
hope of recovery and the surrogate desires only to "effectuate the wishes of the patient" [by way of a
substituted judgment].