Reconciling Quinlan and Saikewicz: decision making for the terminally ill incompetent

One of the most perplexing problems in the medicolegal field concerns the criteria on which decisions not to treat terminally ill incompetent patients should be made. These decisions traditionally have been made by physicians in hospitals--sometimes with the assistance of the patient's family--on the basis of their perceptions of the patient's "best interests." Recently, two state supreme courts have ruled on this question. The New Jersey Supreme Court, in the Quinlan case, developed a medical prognosis criterion, and permitted the patient's guardian, family, and physicians to apply it with the concurrence of a hospital "ethics committee." The Massachusetts Supreme Judicial Court, in the Saikewicz case, adopted, on different facts, the test of "substituted judgment" to be applied by a probate court after an adjudicatory hearing. The two cases have been interpreted by many in the medical profession as representing conflicting viewpoints--one supportive of traditional medical decision making and the other distrustful of it. It is the thesis of this Article that Quinlan and Saikewicz are in fundamental agreement and can be reconciled by the next state supreme court that rules on this question. Both courts enunciate a constitutional right to refuse life-sustaining treatment, based on the right to privacy. They agree that incompetents should be afforded the opportunity to exercise this right, and that certain state interests can overcome it. They agree also that physicians should be permitted to make medical judgments, and that societal judgments belong in the courts. The differences in how the opinions are perceived result from the interplay of several factors: the differences in the facts of the cases; the inarticulate use of the term "ethics committee" by the Quinlan court; the literal interpretation of the role of such a committee by the Saikewicz court; a desire for 100 percent immunity on the part of physicians and hospital administrators in Massachusetts; and advice from their counsel on how such immunity can be guaranteed. It is the author's hope that this Article will help to dispel much of the misinformation surrounding these two cases, and to refocus the debate on how decisions should be made for the terminally ill incompetent patient on the real issues regarding criteria and the decision-making process that remain to be resolved.     

Maturity of judgment in adolescence: Psychosocial factors in adolescent decision making

To date, analyses of differences between adolescents' and adults' judgment have emphasized age differences in cognitive factors presumed to affect decision making. In contrast, this article examines research and theory on threepsychosocial aspects of maturity of judgment: responsibility, temperance, and perspective. For several psychosocial dimensions of maturity that are likely to affect judgment, the existing pvidence, while indirect and imperfect, indicates that the greatest differences are found in comparisons between early adolescents versus middle and late adolescents. Developmental research on maturity that focuses specifically on mid-and late adolescence, that simultaneously examines both cognitive and noncognitive factors, and that investigates the relation between these factors and the ability to make good decisions is greatly needed.     

Preference for decision control in organizational decision making

Two studies examined preference for authority or subordinate decision control in dispute resolution and allocation procedures in an organizational setting. In both studies, a marked preference for the authority/subordinate sharing of decision control was found. In Study 1, nearly one third of respondents preferred that subordinates share decision control with supervisors in both dispute and allocation situations; for several of the situations decision sharing was the modal preference. The study also found a tendency to prefer subordinate decision control in disputes but supervisor decision control in allocations. In Study 2, again the most preferred procedure was one in which subordinates shared decision control with their supervisors. The procedure high in decision sharing was rated as the one most fair. It was also rated as more likely to improve relationships among members and to result in the best decision. Some differences in preference for decision control and decision sharing depending upon social factors predominant in the setting were found.