Patients who are minimally conscious yet are unable to perform basic life-sustaining functions due to something other than a terminal illness may not be disconnected from life support unless the patient has left explicit directions to that effect, ruled the California Supreme Court.
The 6-0 opinion was issued Thursday, settling a 5-year-old lawsuit between family members of a brain-damaged patient.
Robert Wendland of Stockton crashed his pickup truck in September 1993 after he had been drinking. Wendland’s was the only vehicle involved, but the crash left him brain damaged, unable to walk, talk, eat or drink, or take himself to the bathroom. He was given a feeding and hydration tube, and over time, the man became semi-conscious.
With therapy, Wendland was eventually able to react to his environment, though inconsistently. But two years after the accident, Wendland’s wife, Rose, asked doctors to remove the feeding tubes that kept him alive. Before the crash, said Mrs. Wendland, her husband said he would not want to live without his faculties.
But Wendland’s mother and sister, Florence Wendland and Rebekah Vinson, objected to Rose’s decision and took her to court. The case eventually made its way to the California Supreme Court. During proceedings, however, Wendland died from pneumonia, with the feeding tube still in place. The court decided to continue with the case, since it believed the issue was bound to come up again with future patients.
The unanimous decision was that feeding tubes may not be removed from a conscious patient who is not terminally ill unless a patient has left explicit instructions otherwise. Past case law and current state statutes have allowed the removal of life support when a patient is terminally ill or in a permanent comatose state. While that precedent remains, the new ruling covers a gray area not previously explored by the courts or the legislature.
“Our decision today affects only a narrow class of persons: conscious conservatees who have not left formal directions for heath care and whose conservators proposed to withhold life-sustaining treatment for the purpose of causing their conservatees’ deaths,” the opinion states.
The ruling confirms that a competent patient’s right to refuse life-sustaining medical treatment is a fundamental right. It also requires conservators to provide “clear and convincing” evidence that the patient would want life support removed.
“The decision is pretty narrow,” said Dana Cody, executive director of Life Legal Defense Foundation, who said she is “elated” by the decision. “If you don’t have a directive, and you’re incapacitated like Robert was, and it’s unclear on what you would or wouldn’t want, the court is going to side with life,” she said.
Life Legal footed the legal bills for Florence Wendland and Vinson with the help of the Alliance Defense Fund and the Home Land Foundation.
Cody noted that Wendland’s life was not being sustained by a machine. He was fed nutrients through a tube because he had lost the ability to swallow.
“While it’s called medical care, it’s really feeding you. His body never shut down. Had the tube been removed, he would have died by dehydration,” she explained.
But the California Medical Association believes the court should have ruled the other way.
“We are disappointed in the court’s decision and fear that patients will be subjected to treatment they do not want,” said Jack Lewin, M.D., chief executive officer of the California Medical Association.
Lewin said he is concerned that it will be difficult for people to prove “clear and convincing evidence.” It is a standard that could only be met if people have executed Advanced Directives, which a minority of individuals have done, according to the CMA.
California law allows people to make their health-care wishes known by way of an Advanced Directive, yet studies show that fewer than 20 percent of individuals have executed such directives, the group states. The written document is a legally recognized way to state desires about health care in any situation in which one is unable to make one’s own decisions, not just when someone is in a coma or is terminally ill.
