State Supreme Court on Life Support and Right to Die:
Put it in Writing
(SAN FRANCISCO) -- A family is not free to end life support for an incapacitated loved one simply because he had said he would not want to live like a vegetable, the California Supreme Court ruled Thursday in a closely watched right-to-die case.
The justices, ruling 6-0, noted that the incapacitated man in question was not hospitalized in a vegetative state but instead was conscious, albeit seesawing in a twilight state that provided him no means to care for himself following a 1993 auto accident.
Conservatorship of Robert Wendland, S087265
The man's wife, Rose Wendland of Stockton, sought to pull the feeding tubes that kept alive her husband, Robert. She said he had told her months before the accident that he never wanted to live like a vegetable.
"These two conversations do not establish by clear and convincing evidence that the conservatee would desire to have his life-sustaining treatment terminated under the circumstances in which he now finds himself," Justice Kathryn Mickle Werdegar wrote.
The court cautioned, however, that it was not setting a broad standard when conservators could pull the plug on conservatees. Instead, its decision affects "only a narrow class of persons: conscious conservatees who have not left formal directions for health care and whose conservators propose to withhold life-sustaining treatment for the purpose of causing their conservatees' deaths."
But medical ethicists estimate that 15 percent of U.S. adults have drafted such wills or designated such powers to others. And now some ethicists are uncertain whether someone could ever be explicit enough to carry out their wishes to die.
The case began in 1995, when Rose Wendland thought she was carrying out her husband's wishes when she directed doctors to pull his feeding tubes, two years after the accident left him in a near-vegetative state.
But the woman's wishes were blocked and have been embroiled in the courts ever since, reigniting national debate over when loved ones can make such directives when no will or other written document verifies those wishes.
Robert Wendland died last month in a Lodi hospital from pneumonia, but the justices ruled on the case anyway to clarify unsettled law.
"The court has told us that, if you want to have a say in your end-of-life decision-making, you better put it in an advance, written directive," said Jon B. Eisenberg, an Oakland attorney representing 43 medical ethicists who urged the court to abide by the wife's wishes. "The problem here is: I don't know how you do that in a manner that covers all of the possibilities."
During oral arguments in the case in May, Justice Janice Rogers Brown alluded to the point Eisenberg has raised. Although she signed Thursday's opinion, she said from the bench that, even had Robert documented his desire to die, there's no way to accurately predict an exact medical condition for which somebody might want to pull the plug.
"How could you ever meet that?" she asked in open court.
Rose Wendland assailed the ruling, saying she only wanted to pull the plug to follow her husband's desires.
"Thank God that he died. His pain would be even greater with the decision that was made," she said. "It was Robert's wishes to never be in the state that he was in."
The state high court's ruling came three decades after a New Jersey court said the family of Karen Ann Quinlan had the right to withdraw medical treatment to their comatose daughter, who was classified in a permanent vegetative state.
Wendland's right-to-die case was not the first to come before California's justices. In 1993, the state's high court said mentally competent adults may refuse lifesaving medical treatment. That case came three years after the U.S. Supreme Court, ruling in a Missouri case, said there was a constitutional right to withdraw life-sustaining medical treatment, but left it up to the states to devise the legal framework.
An appeals court said Wendland's statements to his wife, and doctors at a Lodi hospital agreeing with the decision, were all that was necessary to end the life of the father of three.
But Robert Wendland's mother, Florence Wendland, fought removing life support and took her case to California's highest court. She claimed her son was not a vegetable and therefore the feeding tubes should not be pulled because those were not his wishes. Doctors said Robert had some ability to think and to sometimes move in his hospital bed, but had no ability to communicate whether he wanted to live or die.
Jamie Hickok Siess, the lawyer who fought removing the feeding tubes, did not return repeated phone calls.
Source: KTVU/Fox2 and Associated Press