A state appeals court Thursday said a family did not have a "legal right" to force Mayo Clinic Florida to administer the controversial drug ivermectin to try to keep alive a COVID-19 patient who was on a ventilator.

A three-judge panel of the 1st District Court of Appeal released a 12-page opinion that detailed reasons that it upheld a decision by a Duval County circuit judge to reject efforts by the wife and son of patient Daniel Pisano to spur the hospital to use the drug.

The Tallahassee-based appeals court made the decision Jan. 14 but did not explain its reasons until Thursday. Jacksonville news organizations reported this week that Pisano, 71, has died.

"Appellants (the family members) frame the issue as whether Mr. Pisano has 'the right to choose life,' but that framing misses the legal dispute at issue," said the opinion by Judges Thomas Winokur, M. Kemmerly Thomas and Robert Long. "No one disputes Mr. Pisano's 'right to choose life.' The question before this court is not whether ivermectin or any other particular treatment is effective or reasonable. The answer to that question is quite obviously of critical importance to Mr. Pisano and his family. But the petition before us presents a legal question that is, while not unrelated, entirely different. The question here is not about whether Mr. Pisano (or his proxies) may 'choose life.' it is whether Mr. Pisano has identified a legal right to compel Mayo Clinic and its physicians to administer a treatment they do not wish to provide. The answer is no."

Pisano's wife, Claudia, and son, Christopher, went to court Dec. 29 to try to force Mayo to provide treatment that included administering ivermectin, an anti-parasitic drug that has drawn widespread controversy about whether it should be given to COVID-19 patients. At the time, Pisano was in a medically induced coma and on a ventilator, according to Thursday's opinion.

The family sought a treatment protocol recommended by physician Ed Balbona, who was not able to treat Pisano at Mayo, which has what is known as a "closed staff." Also, Mayo staff members were not willing to administer the protocol recommended by Balbona.

"In particular, no one on Mayo Clinic's staff was willing to prescribe or administer ivermectin," Thursday's opinion said. "According to Mayo Clinic, there had been no showing that ivermectin is effective in treating late-stage COVID-19 patients like Mr. Pisano, it was not FDA approved to treat COVID-19, and no national or international organization recommends its use for COVID-19. Mayo Clinic prohibits staff from prescribing or administering medications for off-label use that are not supported by medical literature and approved through Mayo Clinic's approval procedures."

Duval County Circuit Judge Marianne Aho denied a request to compel the treatment, leading the family to appeal. But the opinion Thursday backed Aho's decision.

"We greatly empathize with the desire and conviction of appellants to explore every option to assist in the survival of their family member," the appeals court said. "But the rule of law cannot give way to benevolent inclination, regardless of the unpleasantness of the judicial duty. Our role here is to apply the law as written, absent personal sentiment or bias, and to consider only those arguments properly raised."

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