unanimous state Supreme Court made it difficult today for family
members to withdraw life-sustaining medical treatment for a
patient who is brain-damaged but still conscious.
In a major right-to-die case,
the court ruled 6-to-0 this morning 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 instructions of his
Robert Wendland, 49, died last
month of pneumonia after a six-year battle in which his wife
said he should be allowed to die and his mother fought to keep
The case drew wide attention
because Wendland was not in a coma or near death. Instead, he
lingered in a twilight state that some doctors described as
He was paralyzed on his right
side and could not speak, walk or control his bowel functions.
His wife and three children said
he did not recognize them. But his mother said he kissed her
hand and could play catch with a ball.
His wife and brother said Robert
Wendland told them before the accident that he did not want to
be in a vegetative state.
But the justices said today that
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 in the 47-page decision.
The court said its ruling would
not affect most decisions made by conservators of loved ones no
longer competent 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 wrote.
"The decision to treat is
reversible. The decision to withdraw treatment is not."
The court overturned a state
appeals court decision that rejected the "clear and
convincing" standard, saying the law only requires the
wife, Rose Wendland, to act in good faith as her husband's
San Francisco attorney James
Braden, who was appointed by the court to represent Robert
Wendland, said that the decision "eliminates the practical
usefulness of a conservator's decision to end life-sustaining
"It's unfortunate that the
court has chosen a course so far outside the mainstream of
bioethical thinking," said Oakland lawyer Jon Eisenberg,
who filed a friend-of-the-court brief on behalf of six health
care associations and 43 individual bioethicists.
Robert Wendland was severely
injured in September 1993, when his truck rolled over in a solo
accident. He had been drinking before the accident.
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
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 that her husband had told her before he accident that he
would not want to be kept alive in a vegetative state.
Just before the accident, 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 recalls Robert Wendland telling her.
But the trial judge held Rose
Wendland to a high standard, saying that she failed to show with
clear and convincing evidence that Robert would want his
life-sustaining treatment to be withdrawn. He noted that Robert
Wendland was not in a persistent vegetative state nor suffering
from a terminal illness.
A state appeals court reversed
that decision, saying that the trial judge set too a high
Yesterday's decision deals with
an unsettled area of the law. Courts have recognized that a
competent person has a fundamental right to refuse life-
sustaining medical treatment.