Autonomy's responsibility. A gloss on the Wanglie affair

In 1990, 87-year-old Helga Wanglie suffered cardiac arrest while being treated for lung disease at a chronic care facility. When she failed to regain consciousness after being resuscitated, a physician suggested the possibility of discontinuing treatment. At this point, her family requested that she be transferred to a hospital for evaluation. After a variety of procedures failed to improve her condition, the attending physician told the family he was no longer willing to prescribe the respirator because it could not serve her personal medical interests and that her unconscious state precluded the possibility of her appreciating life. However, the family insisted that the hospital provide Ms. Wanglie care, and she remained in treatment until she died 13 months later. The dispute between the hospital and the Wanglie family brings into focus the fundamental premises of the doctor-patient-family relationship. The rules for these relationships-described by such terms as "rights," "responsibilities," and "informed consent"--have both private and public dimensions. Mr. Wanglie had a clear right to be fully informed of all medically reasonable treatments and a right to choose or refuse any therapy the physician prescribed. He did not, however, have a right to demand any treatment he wanted.