11
If Daniel had executed a valid advance directive while still competent, his wishes
could have been granted under Pennsylvania law, since two neurologists agreed that his
PVS was truly a "permanent unconsciousness." But because he was no longer
competent, the court had to decide the issue. It concluded that a close relative and two
physicians without court approval could make a "substituted judgment," based on "what
Daniel would have wanted."
The Goldman case presented a different kind of problem before the Pennsylvania
courts. Mrs. Goldman had expressed specifically that no extraordinary measures be
employed should her quality of life become diminished. Pennsylvania law, however,
does not simply allow a patient to die unless he or she meets certain criteria. We noted
that the advance directive act spells out (1) terminal illness with less than six months to
live, or (2) permanent unconsciousness, including a PVS state. Thus the court ordered
that non-invasive treatments would continue. However, it did take her diminished
capacity into consideration when deciding upon invasive treatments, such as amputation.
Amputation would not be required, because although she was not in a PVS:
She [was] significantly impaired with no prospect of recovery or regaining
any part of the quality of her life.... Under these circumstances, the state's
interest in compelling the amputation of her leg to preserve her life is so
weak that it cannot overcome the right of self-determination (In Re: Anne
Goldman, 9-10).
Analysis
How shall we look at the above decisions as Christians? Regarding the Fiori case,
we first need to investigate the medical definition of PVS. Was the court's working