unanimous California Supreme Court yesterday made it difficult
for family members to withdraw life-sustaining medical treatment
for a loved one who is brain-damaged but still conscious.
In a major right-to-die case,
the court ruled 6 to 0 that the wife of a Stockton man severely
injured in a car accident could not withdraw his feeding tube
because he had left no formal order of his wishes.
Robert Wendland, 49, died last
month of pneumonia after a six-year battle in which his wife
wanted to let him die and his mother fought to keep him alive.
The case is expected to have
national repercussions because Wendland was not in a coma or
near death. Instead, he lingered in a state some doctors
described as "minimally conscious," partially
paralyzed and unable to speak, walk or control his bowel
Courts have allowed families to
withdraw life-sustaining treatment for patients in a comalike
state. The state Supreme Court also has recognized that a
mentally competent adult has a fundamental right to refuse
life-saving medical treatment.
But few courts have ruled on one
of the most agonizing decisions: whether family members can stop
treatment for loved ones still conscious but not competent to
decide their own fate.
In Wendland's case, his wife and
three children said he did not recognize them. But his mother
said that he kissed her hand and could play catch with a ball.
Before the accident, the auto
parts salesman told his wife and brother that he would not want
to be kept in a vegetative state.
But the justices said those
statements were not enough.
A conservator must show "by
clear and convincing evidence, either that the conservatee
wished to refuse life-sustaining treatment or that to withhold
such treatment would have been in his best interests,"
Justice Kathryn Mickle Werdegar wrote.
The court said its ruling would
not affect most decisions made by conservators for loved ones
unable to make their own choices.
"Only the decision to
withdraw life-sustaining treatment, because of its effect on a
conscious conservatee's fundamental rights, justifies imposing
that high standard of proof," Werdegar said.
"The decision to treat is
reversible," she added. "The decision to withdraw
treatment is not."
APPEALS COURT OVERTURNED
The court overturned a state
appeals court decision that rejected that "clear and
convincing" standard. The lower court said that a state law
required only that the wife, Rose Wendland, as her husband's
conservator, act in good faith.
Yesterday's decision was
consistent with rulings in Michigan and Wisconsin refusing to
allow guardians of neurologically damaged patients to withdraw
Janie Hickok Siess, the lawyer
for the mother, Florence Wendland, said she was in
"complete joy" over the court's ruling.
"A lot of people's lives
will be saved," she said. The decision also comes as a
relief to disability groups that had warned that conservators
would try to abuse their powers. "They know if someone is
in Robert's condition, their feeding tube cannot be pulled
without the strictest scrutiny of that decision, " Siess
Rose Wendland called the ruling
"a terrible decision."
"Those justices truly do
not get it," she said. "I don't know how clear and
convincing you can make your decision for someone who does not
know the law."
San Francisco attorney James
Braden, who was appointed by the court to represent Robert
Wendland, said that yesterday's decision "eliminates the
practical usefulness of a conservator's decision to end
WARNING FROM EXPERTS
Bioethics experts warned that
few people actually write an advanced directive of their wishes
or appoint a surrogate to make medical decisions for them.
Unless you take these steps,
"you're not going to be able to count on your end-of-life
wishes being honored unless you have been extraordinarily
specific in what you say to your loved ones," said Oakland
lawyer Jon Eisenberg, who filed a friend-of-the-court brief on
behalf of six health care associations and 43 individual
"The decision fails to
grapple with the fundamental issue of quality of life,"
said Alan Meisel, who teaches bioethics at the University of
Pittsburgh and is author of the book "The Right to
Robert Wendland was severely
injured in September 1993 when his truck rolled over in a solo
He was in a coma for several
months and eventually regained consciousness. With therapy, he
was able to throw and catch a ball and operate an electric
wheelchair with assistance. But he remained severely disabled
both mentally and physically.
Two years later, Rose Wendland
asked that her husband's feeding tube, which had come out
several times, not be reinserted. The hospital's ethics
committee agreed to her request. But Wendland's mother received
an anonymous call from a hospital telling her of the plan.
Florence Wendland obtained a
restraining order preventing her son's wife from taking any
During the trial, Rose Wendland
said her husband had told her before the accident that he would
not want to be kept alive in a vegetative state.
He expressed his concerns when
Rose Wendland decided to turn off the life- sustaining
respirator for her father, who was near death from gangrene.
"I would never want to live like that, and I wouldn't want
my children to see me like that," she recalled Robert
Wendland telling her.
But the trial judge ruled in
favor of Florence Wendland, saying that Rose Wendland failed to
show with "clear and convincing evidence" that her
husband would want his life-sustaining treatment to be
withdrawn. He noted that Robert Wendland was not in a persistent
vegetative state or suffering from a terminal illness.
A state appeals court reversed
that decision, saying that the trial judge set too a high
E-mail Harriet Chiang at firstname.lastname@example.org.