Opinion ID: 1985823
Heading Depth: 1
Heading Rank: 6

Heading: substituted judgment clear and convincing evidence

Text: The Court of Chancery appointed Mrs. Tavel-Lipnick to be the guardian for the person of her mother, Mrs. Tavel, before the 1993 revisions to the Delaware guardianship statute. The Court of Chancery authorized her to exercise powers appropriate to the circumstances. See Severns I, 421 A.2d at 1345. The order appointing Mrs. Tavel-Lipnick as guardian included the following authority: The guardian of the person shall be authorized to make any and all decisions regarding the medical care of Charlotte F. Tavel including those decisions on whether or not heroic measures should be used should Charlotte F. Tavel's condition worsen to the point that that decision needs to be made. Notwithstanding the general authority to make decisions with regard to Mrs. Tavel's medical treatment, Mrs. Tavel-Lipnick filed the petition which is the subject of this appeal. Apparently, Mrs. Tavel-Lipnick was uncertain whether the insertion of the feeding tube or its withdrawal constituted a form of medical treatment governed by the order appointing her as guardian. See Severns I, 421 A.2d at 1345. The majority of jurisdictions have held that removal of an artificial feeding tube is not a death producing agent. McConnell v. Beverly Enterprises-Conn., Inc., Supr., 209 Conn. 692, 553 A.2d 596, 605 (1989). These jurisdictions have determined that, upon removal of an artificial feeding tube, death will result from the underlying disease or ailment, not from the removal. [3] Id.; see In re Gordy, Del.Ch., 658 A.2d 613, 615 n. 1 (1994) (citing Robert M. McCann et al., Comfort Care for Terminally Ill Patients: The Appropriate Use of Nutrition and Hydration, 272 JAMA 1263 (1994)). Subsequent to our decision in Severns I, the majority of the United States Supreme Court, in Cruzan, held that the Due Process Clause of the Fourteenth Amendment establishes a liberty interest that would grant a competent person a constitutionally protected right to refuse [medical treatment, including] lifesaving hydration and nutrition. Cruzan v. Director, Mo. Dept. of Health, 497 U.S. at 279, 110 S.Ct. at 2852. Justice O'Connor further noted in her concurrence that: Artificial feeding cannot readily be distinguished from other forms of medical treatment.... A gastrostomy tube ... must be surgically implanted in the stomach or small intestine.... Requiring a competent adult to endure such procedures against her will burdens the patient's liberty, dignity, and freedom to determine the course of her own treatment. Accordingly, the liberty guaranteed by the Due Process Clause must protect, if it protects anything, an individual's deeply personal decision to reject medical treatment, including the artificial delivery of food and water. Id. at 288-89, 110 S.Ct. at 2857 (O'Connor, J., concurring opinion). The majority opinion in Cruzan also recognized that even for competent individuals determining that a person has a `liberty interest' under the Due Process Clause does not end the inquiry; `whether respondent's rights have been violated must be determined by balancing his liberty interests against the relevant state interests.' Id. (quoting Youngberg v. Romeo, 457 U.S. 307, 321, 102 S.Ct. 2452, 2461, 73 L.Ed.2d 28 (1982)). The Court acknowledged that competent persons may generally refuse medical treatment even at the risk of death, because the right to self-determination ordinarily outweighs any countervailing state interests.... Id. at 273, 110 S.Ct. at 2848. [4] Nevertheless, the Court concluded that, in determining the proper balance between those competing interests after a person becomes incompetent, a State may apply a clear and convincing evidence standard in proceedings where a guardian seeks to discontinue nutrition and hydration of a person diagnosed to be in a persistent vegetative state. Id. at 284, 110 S.Ct. at 2854 (emphasis added). This Court has held that the clear and convincing standard of evidentiary proof is applicable in judicial proceedings involving the termination of parental rights. See In re Stevens, Del.Supr., 652 A.2d 18 (1995). Likewise, that standard has also been applied to other civil proceedings involving the termination of important rights. [5] See Newmark v. Williams, Del.Supr., 588 A.2d 1108 (1991); William H.Y. v. Myrna L.Y., Del.Supr., 450 A.2d 406 (1982); see also Addington v. Texas, 441 U.S. 418, 99 S.Ct. 1804, 60 L.Ed.2d 323 (1979). We hold that the Court of Chancery was correct to apply the clear and convincing standard to this case involving issues concerning Mrs. Tavel's right to withhold or withdraw treatment. [6] After applying the clear and convincing standard, the Court of Chancery concluded that the petitioner ha[d] proven by clear and convincing evidence that Mrs. Tavel would not want the life-sustaining feeding tube if she were competent to make that decision for herself. Accord In re Gordy, 658 A.2d at 619. The Court of Chancery's conclusion is supported by the factual record and is also the product of a logical deductive process. Accordingly, that conclusion is affirmed. Levitt v. Bouvier, Del.Supr., 287 A.2d 671 (1972).