New Jersey's "Granny Doe" squad: arguments about mechanisms for protection of vulnerable patients.

A state government official in New Jersey has written to administrators of the state's nursing homes outlining what he understands to be certain implications of the Conroy, Peter and Farrell decisions of the New Jersey Supreme Court. These include mandatory reporting to and investigation by his office of virtually all cases of contemplated withholding or withdrawal of life-sustaining treatment, even decisions not to hospitalize or dialyze. This directive has aroused health professionals and advocates for patient privacy. The resulting urgent effort to fashion an acceptable alternative to decisional review by government agents is reminiscent of the process which was sparked by the federal government's promulgation of the "Baby Doe regulations" some years ago. Now, as then, a consensus is being fashioned by a wide spectrum of participants. The likely candidate for an alternative to "Granny Doe squads" is, once again, some form or forms of the institutional ethics committee. Any acceptable proposals will have to satisfy the requirement of public confidence in the face of a perception that elderly nursing home patients are particularly vulnerable to "abuse." They should, in the view of these participants in the debate, also acknowledge relevant differences among nursing homes and enhance, rather than discourage, the exercise of responsibility by nursing home leaders and staff members.