Brophy v. New England Sinai Hospital, Inc., 398 Mass. 417, 497 N.E.2d 626 (Mass. 1986)
Brophy v. New England Sinai Hospital is a landmark Massachusetts Supreme Judicial Court decision at the intersection of health law, bioethics, and constitutional privacy.
May a guardian, exercising substituted judgment on behalf of an incompetent patient in a persistent vegetative state, direct the discontinuation of artificial nutrition and hydration delivered by gastrostomy tube; and, if so, can a hospital that objects on moral or ethical grounds be required to comply or, at minimum, allow transfer so the decision can be effectuated elsewhere?
Under Massachusetts law, an incompetent person retains a common-law and constitutional right to refuse medical treatment, which may be exercised through the doctrine of substituted judgment when the patient's actual wishes can be ascertained with reasonable certainty. Artificial nutrition and hydration constitute medical treatment subject to refusal. Countervailing state interests—preservation of life, prevention of suicide, protection of third parties, and maintenance of medical ethical integrity—must be balanced against the patient's rights; when those interests are minimal and the patient's likely choice is clear, the patient's rights prevail. While providers with conscientious objections need not personally participate in the withdrawal, they may not obstruct the patient's lawful choice and must allow transfer to a willing provider.
Yes. Applying substituted judgment, the court concluded that Mr. Brophy would choose to refuse artificial nutrition and hydration under his circumstances. Artificial feeding is medical treatment that may be declined. The hospital need not itself remove the gastrostomy tube if it has conscientious objections, but it may not impede implementation of the decision; it must allow transfer to a facility or personnel willing to carry out the withdrawal.
Brophy is a foundational right-to-die case that cements three propositions central to health law: (1) incompetent patients' treatment rights are exercised via substituted judgment grounded in their known values; (2) artificial nutrition and hydration are medical treatments like any other, not categorically exempt from refusal; and (3) provider conscience does not trump a patient's lawful choice—institutions must at least permit transfer so the decision can be carried out. For law students, Brophy illustrates rigorous substituted-judgment analysis, the balancing of state interests in end-of-life decisions, and practical remedies that reconcile patient autonomy with clinician conscience.