Concerning the case of "Mr. Stevens.".

The case presented for consideration concerns a "Mr. Stevens," a forty-nine year old man who received a severe head wound in an automobile accident. Various medical tests have been performed in the two-year period since the accident, and recent results indicate that a portion of Mr. Stevens's cerebral cortex has atrophied and has been replaced by cerebrospinal fluid. The remainder of his brain and brain-stem appear to be intact and capable of functioning normally. Recent examinations by consulting neurologists have led these physicians to diagnose Mr. Stevens as being in a "persistent vegetative state" (PVS). He is being maintained in an intermediate care nursing facility, expenses being paid from damages awarded to him as a result of the accident. Three months after the accident a gastrostomy tube was inserted into his stomach to supply food and fluids. The physician described Mr. Stevens's ability to swallow at that time as "unsophisticated and reflexive," and there was concern that without the tube food or fluids could enter his lungs and cause further complications. The examining physicians agree that Mr. Stevens could live indefinitely in his present condition so long as artificial feeding and hydration are provided. Mr. Stevens's wife has now petitioned a trial court to authorize the discontinuation of artificial feeding and hydration. She and three of the children agree that he "would not wish to live indefinitely in this way." They invoke in support of this request statements made in reference to his father-in-law, who died after a long illness, lingering for some time in a semi-comatose state somewhat similar to Mr. Stevens's present condition. Stevens had made the comment, heard by the entire immediate family, that it would be better for his father-in-law to "die now rather than linger endlessly in some mindless state." Afterward Mr. Stevens further commented that death had released his father-in-law "from the prison of his own useless body." One year prior to his own accident Mr. Stevens had orally consented to the withholding of "heroic" treatment from his own father, who was almost totally incapacitated by Alzheimer's disease. Mr. Stevens's father continues to live and is able to receive food and fluids by mouth. At the time of his accident Mr. Stevens was teaching high school English and history. His accident occurred as he was driving to a local university, where he was taking graduate courses in pursuit of a Ph.D. in English, with a view toward teaching English at the college level. His own immediate family and his present and former students all agree that he considered the "life of the mind" as requisite to the "fullest human existence." The resolution of the case is complicated by the fact that Mr. Stevens's eldest daughter, who visits him as often as three times a week, is opposed to the removal of the feeding tube. She believes that it would be "wrong to starve her father to death" and that her father would "never want them to do something that was wrong." The nursing staff also objects to the discontinuation of artificial feeding, believing that Mr. Stevens is "higher functioning" than many of the other residents of the facility. In spite of the neurologists' diagnosis of a persistent vegetative state, both the eldest daughter and members of the nursing staff testify that Mr. Stevens appears to interact with them to some degree. Given the incompetency of Mr. Stevens to make decisions concerning his own medical treatment, the trial court must resolve the dispute between Mrs. Stevens and the three children on the one hand, and the eldest daughter and the nursing staff on the other, both as to a matter of fact--the state of Mr. Stevens's consciousness--and a matter of interpretation--that is, the proper interpretation of what Mr. Stevens's wishes might be relative to his medical treatment, were he competent to make such a decision. Several questions of clarification arise naturally in this case. …