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  • Letter to the Editor
  • Published:

Miller Is More Expansive than Previously Reported

Journal of Perinatology volume 25, pages 74–75 (2005)Cite this article

To The Editor:

I read the article by Paris and colleagues1 regarding the Miller case with great interest. I agree with the article's analysis of the issues, but doubt that it will be read as narrowly as the authors hope. I would therefore like to make the following points:

  1. 1

    The core issue in Miller was framed more eloquently by the appellate court: “But does a parent have a right to deny urgently needed life-sustaining medical treatment to their child, i.e., to decide, in effect, to let their child die?”2 Ethicists, physicians and at least one state supreme court3 have recognized that while relatively infrequent, there are those times that the burden of pain and suffering outweighs any benefit of continued existence. Based on the facts of Miller, the Texas Supreme Court has answered the appellate court's question in the negative.

  2. 2

    The Miller decision is now part of the substantive case law of Texas. In legal terms, the newly created Emergency Circumstances exception is the actual holding of the court. However, the court had to lay a foundation first before it could pronounce its holding. It reasoned that infants like Sydney Miller could never be certified terminally ill until they were evaluated after birth. The court further opined that premature infants such as Sydney are born “in distress” and despite both parents being present in the delivery room, the physician had no time to ask for consent and therefore had to make a unilateral “split-second decision.”4 Miller can therefore be read by those inclined to do so, as granting to every Texas physician attending a preterm delivery at 23 or less weeks gestation the discretion of ignoring any antepartum decisions made by informed parents to only provide humane care to the infant. While I share the hope of Paris and colleagues that this new discretion will not be abused, I fear that it might be.

  3. 3

    The potential impact of Miller on antepartum evaluation and counseling must be considered. The most common request for antenatal counseling and delivery planning is for the woman who has been admitted with threatened preterm delivery between 20 and 24 weeks gestation; Miller would seem to apply to these cases. Whether the Emergency Circumstances exception would ever be applied to individuals who have undergone extensive antepartum evaluation and counseling for reasons other than preterm delivery remains to be seen. Prospective Texas parents should now understand that despite reaching an informed reasonable decision with their physicians, which is in the best interest of the fetus, to forego resuscitation at birth, their decision might be disregarded if the physician assigned to care for the newborn has not been involved in the prenatal planning, disagrees with the hopelessness of the diagnosis or happens to be culturally driven to provide maximal medical care to every infant despite the diagnosis. I suspect in light of Miller that well-informed prospective Texas parents who have had the benefit of antepartum evaluation and counseling will begin to seek ways to formally ensure that benefit.

  4. 4

    Appellate court judges closely review how their colleagues in other states have resolved thorny issues. My gravest concern is the ease with which other states’ appellate courts could cite Miller favorably and extend the reach of the Emergency Circumstances exception. A close reading of the Amicus Curiae brief prepared by the Texas Right to Life Committee filed on behalf of HCA in Miller would remind anyone that there are those in our society who believe that all infants should receive maximal medical treatment and die a “natural death.”5 While we should respect the values of individuals as they are applied to the treatment of those individuals’ infants, we should not all be forced to accept those values as our standard of care for everyone's infant. This issue is likely to remain alive in our judicial system until the US Supreme Court has a chance to rule decisively in a case with facts similar to Miller. If in the meantime Miller is cited favorably by other states, then it is likely to be viewed as the judicial resuscitation of a different baby.6

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References

  1. Paris JJ, Schreiber MD, Reardon F . The “Emergent Circumstances” exception to the need for consent: the Texas supreme court ruling in Miller v. HCA. J Perinatol. 2004; 24:337–342.

    Article  Google Scholar 

  2. HCA, Inc. v. Miller. 36 S.W.3d 187 (Tex. App.2000).

  3. In re Nikolas E, 720 A.2d 562 (Sup. Jud. Ct. Maine 1998).

  4. Miller v. HCA, Inc.. 118 S.W.3d 75, 2003.

  5. Brief of Amicus Curiae Texas Right to Life Committee, Inc.. filed 2002 in support of respondents, Miller v. HCA, Inc., 118 S.W.3d 75, 2003.

  6. Kopleman LM, Irons TG, Kopleman AE . Neonatologists judge the “Baby Doe” rules. N Engl J Med 1988;318:677–683.

    Article  Google Scholar 

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Authors and Affiliations

  1. University of Missouri School of Medicine Columbia, MO

    Frank I Clark MD, JD

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  1. Frank I Clark MD, JD
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Clark, F. Miller Is More Expansive than Previously Reported. J Perinatol 25, 74–75 (2005). https://doi.org/10.1038/sj.jp.7211190

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