how the report did and did not contribute to the development of the consensus, it becomes clear then that a proper assessment of the success of the President's Commission must be very dependent both upon one's understanding of the context in which it operated and upon one's understanding of its role.


Having seen the importance of context and of role in assessing the accomplishments of the report of the President's Commission, we will begin our assessment of the reports of the New York State Task Force on limiting life-prolonging therapy by looking at the context in which the Task Force was created and in which it issued its reports.

The New York State Task Force was created by Governor Cuomo in 1985 and issued its three major reports in 1986, 1987, and 1992. Two of the six issues it was asked to look at, decision making for those without decisional capacity and discontinuing life-sustaining therapies, relate to our topic.

What was the status of New York law and of thinking in New York on these issues before the Task Force began its work and in the early years of its work? I think that there are a number of points that need to be kept in mind:

  1. New York State had no statutes on the definition of death, on limiting life-prolonging therapy, and on advance directives.

  2. As noted above, the New York courts in 1981 had rejected part of the current consensus. In particular, a decision to limit life-prolonging therapy for an incompetent patient required in New York clear and convincing evidence that the patient would have requested those limitations in the circumstances at hand, rather than surrogate substituted judgments or surrogate judgments of the patient's best interests. In 1988, the New York Court of Appeals, in an opinion28 written by Judge Wachtler (influenced, it has been suggested,29 by a case involving his own mother), reaffirmed that position and allowed for limiting such therapy only when the evidence of the patient's expressed advance wishes applied very specifically to the patient's actual condition.

  3. At least two very well organized groups in New York, the New York State Catholic Conference and the Agudath Israel (an Orthodox Jewish organization), expressed strong and politically influential concerns about components of the consensus on limiting life-prolonging therapy, concerns growing out of their reverence for human life. Some of those concerns will be discussed below. For now, it is sufficient to say that the New York State Task Force operated in a context in which important ethical/

The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement