American medical term “”””Daughter from California syndrome””””

Decision Making in the Incompetent Elderly:
The Daughter from California Syndrome
David W. Molloy; MB BCh MRCPL FRCP(C),t
M Clarnette; MB, BS FRACPt
E Ann Braun MSc MD,+ Martin R Eisemann PhD,+ and B. Sneiderman BA, LLB LLMS
ecision-making regarding
the
care
the
intact the long line o
(ose5
beginning with In the
mentally incornpetent patient is often com-
Matter of Karen Quinlan in which state supreme courts
Plicated by legal
econornic
and cthi-
have held that decisions to terminate life
~prolonging
ah
Cal factors
that affect case management.
Treatment for incompetent Patients should rest with
The incompetent Palient requires
advocate
the patient’s family and doctors
The courts have
sponsibility that generally falls upon the family
further ruled that the courtroom should be the Forum
conflict over
Patient arises
within
the family the
of last resort for decision-making involving Uhe term
result may well be inimical
effective patient man
malon
of life-prolonging
treatment for
wncompetent
agement.
Paticnts
June
25th,
1990
the united
States
Supreme
the view of the judges
However, they have
role
Court issues its decision in Cruzan
Director, Missouri
t0 Play when there is in-family conflict that cannot be
Department of Health
the first case in which the high
resolved in the health care setting
In that event judi
Court
considered
the
termination
of life-prolonging
cial action
called tor in which either the
mlake3
measures for incompetent patients
dccision
the training decision or elsc vests that authentication
the Court upheld the decision by the Missouri Supreme
guardian apPointed to act on the Patient’s behalf. (The
Court that the feeding tube of Vancy Cruzan
patient
trend in the more recemt Cases is
assign the decision
persistent vegetable state since 1983 could not be
guardian;
the court itself )
removed at the request of her parents
The reason was
The “Daughter from California Syndrome
Descripes
that there was no ‘clear and convincing
evidence that
@Tiu
such in-family predicament. In this
Ca5(
an adult
the Patient when competent had specifically indicated
daughter who had
not see her mother for
years;
that she would no wish
tube-fed if she ever
aPeared on the scene when critical health care options
became irreversibly unconscious.
New’T
considered Tor her incompetent mother.
The
naTTo
import of the decision in Cruzan must
Upon being faced with her mother’
cunditior
be stressed
The Court ruled that it constitutionally
the daughter responded with acute denial as well as
permissible for
state
require that life-prolonging
anger
resentment
Directed
against the medical
meaourt
Incompetent Patient remains In Place
stafl She refused t0 come t0
lerTs
with her mother
unless the
Patient had left behind
clear directive
condition,
demanded inPpropriate
aggressive
care.
excluding such
YDum-
the vent of
futurc state
and
impeded the management of the case
of incompetency
The Court did not rle that such
Health care directives
ofter
Possible solution to
state rle
mandatory but simply that
state may
These problems by allowing competent individuals to
rule ir
chooscs
The decision in Cruzan thus leaves
choose their
Uwrt
health
elT
berore they becuriie’
competent
We report this case because it illustrates
many or the features o this syndrome.
Roger
Cuurt
beinp
and