Anderson v. St. Francis-St. George Hosp., Inc.

• Decision Date: 10 October 1996
• Docket Number: FRANCIS-ST,No. 95-869,95-869
• Citation: 671 N.E.2d 225,77 Ohio St.3d 82
• Parties: , 65 USLW 2273 ANDERSON, Admr., Appellee, v. ST.GEORGE HOSPITAL, INC., Appellant.
• Court: Ohio Supreme Court

Page 82

77 Ohio St.3d 82

671 N.E.2d 225, 65 USLW 2273

ANDERSON, Admr., Appellee, v. ST. FRANCIS-ST. GEORGE HOSPITAL, INC., Appellant.

No. 95-869.

Supreme Court of Ohio.

Submitted May 7, 1996.

Decided Oct. 10, 1996.

On May 25, 1988, Edward H. Winter was admitted to appellant St. Francis-St. George Hospital, Inc. ("the hospital"), complaining of chest pains and fainting. Shortly after admission, Winter discussed his treatment with his personal physician, Dr. George E. Russo, who supplemented the orders on Winter's chart to provide for "No Code Blue," indicating Winter's desire not to be resuscitated. Winter's reason for not wanting to be resuscitated stemmed from his fear of suffering the same fate as his wife, who had seriously deteriorated following an emergency resuscitation. However, Dr. Russo did not order the discontinuation of the cardiac monitoring equipment.

In the early morning hours of May 28, Winter suffered ventricular tachycardia. Despite the "No Code Blue" order, and due in part to the fact that Winter was attached to a heart monitor, a nurse defibrillated Winter once and succeeded in reviving him. Upon regaining consciousness, Winter expressed his gratitude to the nurse for saving his life. When apprised of Winter's condition, Dr. Russo ordered Lidocaine to be re-administered to treat Winter and to prevent further attacks. Two hours later, Winter endured another episode, which ended spontaneously due to the Lidocaine.

The following day, Dr. Russo ordered that the Lidocaine and the heart monitor be discontinued. On May 30, Winter suffered a stroke that paralyzed his right side. In June, he was transferred to another hospital, from which he was released in July. Winter lived with his daughter and son-in-law for several months following his discharge from the hospital. In April 1989, Winter moved to a nursing home. Although Winter remained partially paralyzed until his death in April 1990, he enjoyed numerous visits and outings with his family.

Before his death, Winter initiated this action against the hospital for damages resulting from the hospital's failure to obey the "No Code Blue" order. After Winter died, appellee Keith W. Anderson, administrator of Winter's estate, amended the complaint to substitute himself as plaintiff.

The trial court granted summary judgment to the hospital, finding that there is no cause of action in Ohio for the wrongful administration of life-prolonging medical treatment, i.e., "wrongful living." The First District Court of Appeals affirmed that judgment, but reversed in part and remanded the cause for a determination of whether damages other than for the prolongation of life were caused by the hospital. See Anderson v. St. Francis-St. George Hosp. (1992), 83 Ohio App.3d 221, 614 N.E.2d 841.

On remand, the trial court again granted summary judgment for the hospital. Applying standards based on negligence and battery, a different panel of the same court of appeals that had considered the first appeal reversed the judgment of the trial court, holding that Anderson may be entitled to damages for the reasonably foreseeable consequences of an unwanted resuscitation. The court remanded the cause for further proceedings in accordance with its reasoning.

This cause is now before this court upon the allowance of a discretionary appeal.

William C. Knapp, Cincinnati, for appellee.

Dinsmore & Shohl, Deborah R. Lydon, June Smith Tyler and Sara Simrall Rorer, Cincinnati, for appellant.

Bricker & Eckler, James J. Hughes, Jr. and Catherine M. Ballard, Columbus, urging reversal for amici curiae, Ohio Hospital Association and Ohio State Medical Association.

MOYER, Chief Justice.

We are presented with the following question: Where a medical provider administers a life-prolonging treatment or procedure to a patient against the patient's instructions, is the medical provider liable for all foreseeable consequential damages resulting from the treatment or procedure? This is a case of first impression, and presents this court with the issues raised by a claim of "wrongful living." In its simplest form, the question becomes: Is "continued living" a compensable injury?

American jurisprudence has developed at least three civil actions relating to the beginning and the extension of life: "wrongful life," "wrongful birth" and "wrongful living." Generally, a claim for "wrongful life" is brought by a child seeking damages against a physician or hospital for negligently failing to properly sterilize the parent. See Bowman v. Davis (1976), 48 Ohio St.2d 41, 45, 2 O.O.3d 133, 135, 356 N.E.2d 496, 499, fn. 3.

A "wrongful birth" action is a claim brought by the parents of an impaired child seeking to recover damages for the birth of the child. The parents claim that due to the negligence of the physician, they were prevented from exercising their right to terminate the pregnancy or avoid conception altogether. See Johnson v. Univ. Hospitals of Cleveland (1989), 44 Ohio St.3d 49, 51, 540 N.E.2d 1370, 1372.

In a claim for "wrongful living," which is the basis for recovery in this case, the plaintiff does not assert a claim based on a life coming into being. Rather, the plaintiff asserts a right to enforce an informed, competent decision to reject live-saving treatment. This claim is inextricably linked to, and arises directly out of, the right to die recognized in Cruzan v. Director, Missouri Dept. of Health (1990), 497 U.S. 261, 110 S.Ct. 2841, 111 L.Ed.2d 224. Thus, in a "wrongful living" action, the plaintiff is asserting a liberty interest in refusing unwanted medical treatment. It is the denial of this liberty interest, when the medical professional either negligently or intentionally disregards the express wishes of a patient, that gives rise to the wrongful living cause of action.

Some form of valuation of life pervades the legal issue in all three of the causes of action. In reality, a claim of wrongful living is a damages concept, just as a claim for "wrongful whiplash" or "wrongful broken arm," and must necessarily involve an underlying claim of negligence or battery. A negligence claim requires proof of the following elements: duty, breach of duty, causation, and damages. Menifee v. Ohio Welding Products, Inc. (1984), 15 Ohio St.3d 75, 15 OBR 179, 472 N.E.2d 707. A battery claim, while sharing the elements of causation and damages, does not require the proving of a duty and a breach of that duty, but rather an intentional, unconsented-to touching. Love v. Port Clinton (1988), 37 Ohio St.3d 98, 524 N.E.2d 166. Under both claims, a defendant is liable only for harms that are proximately caused by the tortious act. It is the defining of the harm giving rise to damages that is uniquely difficult in a claim of "wrongful living."

Because a person has a right to die, a medical professional who has been trained to preserve life, and who has taken an oath to do so, is relieved of that duty and is required by a legal duty to accede to a patient's express refusal of medical treatment. Whether intentional or negligent, interference with a person's legal right to die would constitute a breach of that duty to honor the wishes of the patient.

Where a breach of duty has occurred, liability will not attach unless there is a causal connection between the conduct of the medical professional and the loss suffered by the patient.

The standard test for establishing causation is the sine qua non or "but for" test. Thus, a defendant's conduct is a cause of the event (or harm) if the event (or harm) would not have occurred but for that conduct; conversely, the defendant's conduct is not the cause of the event (or harm) if the event (or harm) would have occurred regardless of the conduct. Prosser & Keeton, Law of Torts (5 Ed.1984) 266.

For purposes of a "wrongful living" cause of action, the event or loss for which the plaintiff seeks damages is neither death nor life, but the prolongation of life. Thus, once it is established that but for the conduct of the medical professional, death would have resulted, the causation element of a "wrongful living" claim is satisfied.

Assuming that the plaintiff can show a duty, breach of the duty, and proximate cause between the breach and the prolongation of life, the difficult issue is what damages flow from the "harm" caused the plaintiff. There is perhaps no issue that better demonstrates the outer bounds of liability in the American civil justice system than this issue.

This court has recognized "the impossibility of a jury placing a price tag" on the benefit of life. Johnson, supra, 44 Ohio St.3d at 58, 540 N.E.2d at 1378. We have also disapproved of awarding damages on the relative merits of "being versus nonbeing." Bowman, supra, 48 Ohio St.2d at 45, 2 O.O.3d at 135, 356 N.E.2d at 499, fn. 3. These views are consistent with the views expressed by the courts of other states. Cockrum v. Baumgartner (1983), 95 Ill.2d 193, 201, 69 Ill.Dec. 168, 172, 447 N.E.2d 385, 389 (finding that human life cannot be a compensable harm, and stating that "the benefit of life should not be outweighed by the expense of supporting it"); Becker v. Schwartz (1978), 46 N.Y.2d 401, 412, 413 N.Y.S.2d 895, 900, 386 N.E.2d 807, 812 (finding courts not equipped to handle the task of comparing the value of life in an impaired state and nonexistence); Lininger v. Eisenbaum (Colo.1988), 764 P.2d 1202, 1212 (concluding that "life, however impaired and regardless of any attendant expenses, cannot rationally be said to be a detriment" when compared to the alternative of nonexistence).

In Winter's first appeal, the court of appeals properly concluded that there is no cause of action for "wrongful living" and remanded for a determination of several issues related to traditional negligence and battery. 83 Ohio App.3d 221, 614 N.E.2d 841. In the second appeal, the court held that a patient may recover damages based upon the torts of negligence or battery for all the foreseeable...