Ruling in a closely watched right-to-die case, the California Supreme Court on Thursday made it extremely difficult to withdraw life support from nearly comatose patients who have not made it clear in writing that they would rather end their lives than survive on feeding tubes or machines.
The justices, tackling an issue that touched on a host of legal, ethical and medical questions, found that they would not have allowed the withdrawal of life support from a Stockton man who survived eight years in a hospital stuck between consciousness and coma after an automobile accident. Robert Wendland, whose family fought in the courts for years over his fate, died of pneumonia three weeks ago, but the state Supreme Court went forward with a ruling to provide guidance to families, doctors and judges caught in the same dilemma in the future.
The Supreme Court held that ``clear and convincing'' evidence of a patient's wishes -- such as a written directive -- must be shown before the law would allow ending a life; the justices found that Wendland's comments to family members were insufficient to meet that standard. Even though the ruling did not limit such evidence to written instructions, the court sent a clear signal to residents of California, the majority of whom do not put their wishes on paper.
The ruling struck a blow to right-to-die advocates because it established an exacting standard for when it is permissible to withdraw life-sustaining medical treatment to the increasing number of patients such as Wendland who find themselves trapped in a cognitive ether, severely disabled but short of what medical science calls a ``persistent vegetative state.''
The U.S. Supreme Court already has ruled on when it might be appropriate to withdraw such treatment for comatose patients, but the Wendland case took the law to a new threshold, with implications for everyone from accident victims to Alzheimer's patients.
In a unanimous, 50-page ruling, the justices concluded that the law should set an exceedingly high threshold for cutting off medical treatment. ``The decision to treat is reversible. The decision to withdraw treatment is not,'' Justice Kathryn Mickle Werdegar wrote for the court.
The ruling puts an end to a dramatic family saga that stemmed from Robert Wendland's 1983 drunk-driving accident, when he flipped his pickup truck and wound up in a coma for 17 months. Wendland emerged from the coma, but was confined to a Lodi hospital with limited functions, particularly in recent years. For a time, Wendland could respond to some verbal commands, and at one point could move around in a motorized wheelchair.
Rose Wendland, who sought for six years to withdraw her husband's feeding tubes, was distraught over the Supreme Court's ruling, warning that the justices have ``sentenced all of us to living death.'' Rose Wendland and her children maintained that Robert made it clear before the accident he would not want to live tethered to feeding tubes, but Robert's mother, Florence, challenged it in court.
``It's sad we have no control over our lives without writing everything down,'' Rose Wendland said Thursday. ``I don't know how clear anybody else could be, ever.''
Florence Wendland, who in a recent interview called her son ``disabled,'' could not be reached for comment. But Janie Hickok Siess, the lawyer for 79-year-old Florence Wendland, viewed the decision as a check against people who are too willing to pull the plug on the infirm.
``It will save an immeasurable number of lives,'' Siess said. ``It's crystal clear what you have to show. A clear and convincing standard is a high standard, but you are talking about killing people.''