Nutrition and Hydration
This is a brief summary of Wisconsin Supreme Court decisions on nutrition and hydration, giving the citations, date, and holding.
In re Guardianship of L.W., 167 Wis.2d 53 (1992). L.W. had a long history of schizophrenia and had been institutionalized since 1951. He had no close relatives or friends, and had never indicated his wishes concerning life-sustaining medical treatment to anyone. He may “never have been competent.” On May 25, 1989, a corporation was appointed as guardian for L.W. About a week later, 79-year-old L.W. suffered a cardiac arrest. A few days later L.W.’s attending physicians told the guardian that “L.W. was in a chronic, persistent vegetative state” and that if his “condition did not improve within the following four weeks, they would request the guardian to consent to withdrawal of all life-sustaining medical treatment, including artificial nutrition and hydration, and thus occasion L.W.’s death.” On June 8, 1989, the guardian petitioned the court to determine whether the guardian had authority to consent to such withdrawal.
The Wisconsin Supreme Court concluded “that an incompetent individual in a persistent vegetative state has a constitutionally protected right to refuse unwanted medical treatment, including artificial nutrition and hydration” and “that a court-appointed guardian may consent to withdrawal of such treatment where it is in the ‘best interests’ of the ward to do so.” The Court stressed that its “opinion is limited in scope to persons in a persistent vegetative state.”
The “guardian must begin with a presumption that continued life is in the best interests of the ward.” However, this presumption can be overcome by a guardian’s “good faith” assessment of countervailing factors. The Court rejected the clear and convincing evidence standard for determining the person’s wishes. When nontreatment is in the ward’s best interests, “the guardian has not only the authority to but a duty to consent to the withholding or withdrawal of treatment.” The Court’s ruling was 6-1, with Justice Steinmetz dissenting.
In the Matter of the Guardianship and Protective Placement of Edna M.F., 210 Wis.2d 557 (1997). At the time of the case, Edna M.F. was a 71-year-old woman who had been diagnosed with Alzheimer’s dementia. She was bedridden, but doctors indicated that she responded to stimulation from voice and movement. She also appeared alert at times, with her eyes open, and she responded to mildly noxious stimuli. Her condition did not meet the definition of a “persistent vegetative state”. In 1988, a permanent feeding tube was surgically inserted. She was breathing without a respirator.
On January 12, 1995, Edna’s sister and court-appointed guardian, Betty Spahn, sought permission to direct the withholding of Edna’s nutrition and hydration, claiming that her sister would not want to live in this condition. Spahn asked the Wisconsin Supreme Court to extend its ruling in the L.W. case to include incompetent wards who are not in a “persistent vegetative state”.
The Wisconsin Supreme Court unanimously refused to extend the scope of L.W. to include incompetent patients who are afflicted with incurable or irreversible conditions of health. The Court held that if a ward is not in a “persistent vegetative state,” it is not in the best interests of the ward “as a matter of law” to withdraw life-sustaining treatment, including a feeding tube, “unless the ward has executed an advance directive or other statement clearly indicating his or her desires.”
There was very little evidence of what Edna’s desires would be under the current circumstances. A statement made 30 years ago was too remote. There was no clear statement of what her desires would be under the current conditions. She never executed any advance directives expressing her wishes while she was competent. In Wisconsin there is “a presumption that continuing life is in the best interests of the ward.” The Court held that there was not enough evidence to rebut the presumption that Edna would choose life.