Opinion ID: 2525487
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Heading: The Relevant Legal Principles

Text: The ultimate focus of our analysis must be section 2355, the statute under which the conservator has claimed the authority to end the conservatee's life and the only statute under which such authority might plausibly be found. Nevertheless, the statute speaks in the context of an array of constitutional, common law, and statutory principles. The Law Revision Commission, which drafted the statute's current version, was aware of these principles and cited them to explain and justify the proposed legislation. Because these principles provide essential background, we set them out briefly here, followed by the history of the statute. [8]
One relatively certain principle is that a competent adult has the right to refuse medical treatment, even treatment necessary to sustain life. The Legislature has cited this principle to justify legislation governing medical care decisions (§ 4650), and courts have invoked it as a starting point for analysis, even in cases examining the rights of incompetent persons and the duties of surrogate decision makers (e.g., Drabick, supra, 200 Cal.App.3d 185, 206, 245 Cal.Rptr. 840; Barber, supra, 147 Cal.App.3d 1006, 1015, 195 Cal.Rptr. 484). This case requires us to look beyond the rights of a competent person to the rights of incompetent conservatees and the duties of conservators, but the principle just mentioned is a logical place to begin. That a competent person has the right to refuse treatment is a statement both of common law and of state constitutional law. In its common law form, the principle is often traced to Union Pacific Railway Co. v. Botsford (1891) 141 U.S. 250, 251, 11 S.Ct. 1000, 35 L.Ed. 734, in which the United States Supreme Court wrote that [n]o right is held more sacred, or is more carefully guarded, by the common law, than the right of every individual to the possession and control of his own person, free from all restraint or interference of others, unless by clear and unquestionable authority of law. Applying this principle, the high court held that the plaintiff in a personal injury case was not required to submit to a surgical examination intended to reveal the extent of her injuries. (Ibid.) Courts in subsequent cases relied on the same principle to award damages for operations performed without the patient's consent. The landmark case is Schloendorff v. Society of New York Hospital (N.Y.1914) 211 N.Y. 125, 105 N.E. 92, 93, in which Judge Cardozo wrote that [e]very human being of adult years and sound mind has a right to determine what shall be done with his own body; and a surgeon who performs an operation without his patient's consent commits an assault, for which he is liable in damages. We adopted this principle in Cobbs v. Grant (1972) 8 Cal.3d 229, 242, 104 Cal. Rptr. 505, 502 P.2d 1, adding that the patient's consent to treatment, to be effective, must be an informed consent. Most recently, in Thor v. Superior Court (1993) 5 Cal.4th 725, 21 Cal.Rptr.2d 357, 855 P.2d 375, we held that the common law right of a competent adult to refuse life-sustaining treatment extends even to a state prisoner; we thus absolved prison officials and medical personnel of any duty to provide artificial hydration and nutrition against the will of a quadriplegic prisoner who needed such treatment to survive. The Courts of Appeal have found another source for the same right in the California Constitution's privacy clause. (Cal. Const., art. I, § 1.) The court in Bartling v. Superior Court (1984) 163 Cal.App.3d 186, 209 Cal.Rptr. 220 held that a competent adult with serious, probably incurable illnesses was entitled to have life-support equipment disconnected over his physicians' objection even though that would hasten his death. The right of a competent adult patient to refuse medical treatment, the court explained, has its origins in the constitutional right of privacy. This right is specifically guaranteed by the California Constitution (art. I, § 1). . . . The constitutional right of privacy guarantees to the individual the freedom to choose to reject, or refuse to consent to, intrusions of his bodily integrity. (Id. at p. 195, 209 Cal.Rptr. 220.) To the same effect is the decision in Bouvia v. Superior Court (1986) 179 Cal.App.3d 1127, 225 Cal. Rptr. 297, in which the court directed injunctive relief requiring a public hospital to comply with a competent, terminally ill patient's direction to remove a nasogastric feeding tube. The right to refuse medical treatment, the court wrote, is basic and fundamental. . . . Its exercise requires no one's approval. It is not merely one vote subject to being overridden by medical opinion. (Id. at p. 1137, 225 Cal.Rptr. 297; see also Rains v. Belshe (1995) 32 Cal.App.4th 157, 169, 38 Cal.Rptr.2d 185, Drabick, supra, 200 Cal.App.3d 185, 206, fn. 20, 245 Cal.Rptr. 840, Keyhea v. Rushen (1986) 178 Cal.App.3d 526, 540, 223 Cal.Rptr. 746, Foy v. Greenblott (1983) 141 Cal.App.3d 1, 11, 190 Cal.Rptr. 84 [all describing, albeit perhaps in dictum, the competent person's right to refuse medical treatment as protected by the state constitutional right to privacy].) In Thor v. Superior Court, supra, 5 Cal.4th 725, 21 Cal.Rptr.2d 357, 855 P.2d 375, as mentioned, we based our conclusion that a prisoner had the right to refuse life-sustaining treatment solely on the common law without also considering whether the state Constitution provided similar protection. But Thor does not reject the state Constitution as a basis for the right. More importantly, we have since Thor determined that the privacy clause does protect the fundamental interest in personal autonomy. Where the case involves an obvious invasion of an interest fundamental to personal autonomy, e.g., freedom from involuntary sterilization or the freedom to pursue consensual familial relationships, a `compelling interest' must be present to overcome the vital privacy interest. ( Hill v. National Collegiate Athletic Assn. (1994) 7 Cal.4th 1, 34, 26 Cal.Rptr.2d 834, 865 P.2d 633; see also American Academy of Pediatrics v. Lungren (1997) 16 Cal.4th 307, 340, 66 Cal.Rptr.2d 210, 940 P.2d 797 [reaffirming Hill and adding to its list of `obvious invasion[s] of . . . interests] fundamental to personal autonomy' (italics omitted) a law interfering with the decision whether to bear a child].) In comparison with these examples, the competent adult's decision to refuse life-sustaining medical treatment must also be seen as fundamental. Federal law has little to say about the competent person's right to refuse treatment, but what it does say is not to the contrary. The United States Supreme Court spoke provisionally to the point in Cruzan v. Director, Missouri Dept. of Health (1990) 497 U.S. 261, 110 S.Ct. 2841, 111 L.Ed.2d 224 ( Cruzan ). At issue was the constitutionality of a Missouri law permitting a conservator to withhold artificial nutrition and hydration from a conservatee in a persistent vegetative state only upon clear and convincing evidence that the conservatee, while competent, had expressed the desire to refuse such treatment. The court concluded the law was constitutional. While the case thus did not present the issue, the court nevertheless acknowledged that a competent person[`s] . . . constitutionally protected liberty interest in refusing unwanted medical treatment may be inferred (id. at p. 278, 110 S.Ct. 2841) from prior decisions holding that state laws requiring persons to submit to involuntary medical procedures must be justified by countervailing state interests. The logic of such cases would, the court thought, implicate a competent person's liberty interest in refusing artificially delivered food and water essential to life. (Id. at p. 279, 110 S.Ct. 2841.) Whether any given state law infringed such a liberty interest, however, would have to be determined by balancing the liberty interest against the relevant state interests, in particular the state's interest in preserving life. (Id. at p. 280,110 S.Ct. 2841.) In view of these authorities, the competent adult's right to refuse medical treatment may be safely considered established, at least in California. The same right survives incapacity, in a practical sense, if exercised while competent pursuant to a law giving that act lasting validity. For some time, California law has given competent adults the power to leave formal directions for health care in the event they later become incompetent; over time, the Legislature has afforded ever greater scope to that power. The former Natural Death Act (Health & Saf.Code, former § 7185 et seq., added by Stats.1976, ch. 1439, § 1, p. 6478, and repealed by Stats.1991, ch. 895, § 1, p. 3973), as first enacted in 1976, authorized competent adults to direct health care providers to withhold or withdraw life-sustaining procedures under very narrow circumstances only: specifically, in the event of an incurable condition that would cause death regardless of such procedures and where such procedures would serve only to postpone the moment of death. In findings accompanying the law, the Legislature expressly found that adult persons have the fundamental right to control the decisions relating to the rendering of their own medical care (id., § 7186) and explained the law as giving lasting effect to that right: In recognition of the dignity and privacy which patients have a right to expect, the Legislature hereby declares that the laws of the State of California shall recognize the right of an adult person to make a written directive instructing his physician to withhold or withdraw life-sustaining procedures in the event of a terminal condition. (Ibid.) In 1991, the Legislature amended the law to permit competent adults to refuse, in advance, life-sustaining procedures in the event of a permanent unconscious condition, defined as an irreversible coma or persistent vegetative state. (Health & Saf. Code, former §§ 7185.5, 7186, subd. (e), added by Stats.1991, ch. 895, § 2, pp. 3974-3975, and repealed by Stats.1999, ch. 658, § 7.) Intervening legislation also enabled a competent adult to execute a durable power of attorney authorizing an agent to withhold[ ] or withdraw[ ] . . . health care . . . so as to permit the natural process of dying, and to make other health care decisions, in the event of the principal's incompetence. (Civ.Code, former § 2443, added by Stats.1983, ch. 1204, § 10, p. 4622, and repealed by Stats.1994, ch. 307, § 7, p.1982.) Effective July 1, 2000, the Health Care Decisions Law (Stats.1999, ch. 658) gives competent adults extremely broad power to direct all aspects of their health care in the event they become incompetent. The new law, which repeals the former Natural Death Act and amends the durable power of attorney law, draws heavily from the Uniform Health Care Decisions Act adopted in 1993 by the National Conference of Commissioners on Uniform State Laws. (See 2000 Health Care Decisions Law and Revised Power of Attorney Law (March 2000) 30 Cal. Law Revision Com. Rep. (2000) p. 49 [preprint copy] (hereafter California Law Revision Commission Report).) Briefly, and as relevant here, the new law permits a competent person to execute an advance directive about any aspect of health care. (§ 4701.) Among other things, a person may direct that life-sustaining treatment be withheld or withdrawn under conditions specified by the person and not limited to terminal illness, permanent coma, or persistent vegetative state. A competent person may still use a power of attorney for health care to give an agent the power to make health care decisions (§ 4683), but a patient may also orally designate a surrogate to make such decisions by personally informing the patient's supervising health care provider. (§ 4711.) Under the new law, agents and surrogates are required to make health care decisions in accordance with the principal's individual health care instructions, if any, and other wishes to the extent known to the agent. (§ 4684; see also § 4711.) All of the laws just mentioned merely give effect to the decision of a competent person, in the form either of instructions for health care or the designation of an agent or surrogate for health care decisions. Such laws may accurately be described, as the Legislature has described them, as a means to respect personal autonomy by giving effect to competent decisions: In recognition of the dignity and privacy a person has a right to expect, the law recognizes that an adult has the fundamental right to control the decisions relating to his or her own health care, including the decision to have life-sustaining treatment withheld or withdrawn. (§ 4650, subd. (a) [legislative findings].) This court made essentially the same point in Thor v. Superior Court, supra, 5 Cal.4th 725, 740, 21 Cal.Rptr.2d 357, 855 P.2d 375, where we described the [former] Natural Death Act and other statutory provisions permitting an individual or designated surrogate to exercise conclusive control over the administration of life-sustaining treatment [as] evidencing] legislative recognition that fostering self-determination in such matters enhances rather than deprecates the value of life. In contrast, decisions made by conservators typically derive their authority from a different basisthe parens patriae power of the state to protect incompetent persons. Unlike an agent or a surrogate for health care, who is voluntarily appointed by a competent person, a conservator is appointed by the court because the conservatee has been adjudicated to lack the capacity to make health care decisions. (§ 2355, subd. (a).) In 1988, the court in Drabick, supra, 200 Cal.App.3d 185, 245 Cal.Rptr. 840, confused these two distinct conceptsthe voluntary act of a competent person and the state's parens patriae powerand on that questionable basis took to a novel conclusion the idea that a person's right to refuse treatment survives incompetence. Drabick figures prominently both in the legislative history of section 2355the statute governing this caseand the parties' arguments. It therefore deserves close attention. At issue in Drabick, supra, 200 Cal. App.3d 185, 245 Cal.Rptr. 840, was a conservator's proposal to end the life of a conservatee by removing a nasogastric feeding tube. The formerly competent conservatee had been unconscious for five years in a persistent vegetative state; physicians opined he would never regain consciousness. While the conservatee had expressed informally his desire not to be kept alive by artificial life support systems, he had not left formal directions for his health care. Former section 2355, subdivision (a) (added by Stats.1979, ch. 726, § 3, pp. 2379-2380, and repealed by Stats.1990, ch. 79, § 13, p. 463) gave the conservator exclusive authority to give consent for such medical treatment . . . as the conservator in good faith based on medical advice determines to be necessary. The court construed this language as also giving the conservator, by necessary implication, . . . power to withhold or withdraw consent to medical treatment under appropriate circumstances. ( Drabick, supra, at p. 200, 245 Cal.Rptr. 840.) Treatment to sustain the life of a permanently unconscious person was not `necessary' within the meaning of former section 2355, the court reasoned, if it offers no reasonable possibility of returning the conservatee to cognitive life and if it is not otherwise in the conservatee's best interests, as determined by the conservator in good faith. ( Drabick, supra, at p. 218, 245 Cal.Rptr. 840.) Counsel appointed to represent the conservatee in Drabick, supra, 200 Cal.App.3d 185, 245 Cal.Rptr. 840, argued that the state's interest in preserving life justified the court in limiting the conservator's powers. The court disagreed. Rather than presenting a conflict between the conservator's decision to terminate life support and the state's interest in preserving life, the Drabick court thought the case was more appropriately viewed as presenting a conflict between two rights belonging to the conservatee: Both the fundamental right to lifeto continue receiving treatmentand the right to terminate unwanted treatment deserve consideration. Someone acting in [the conservatee's] best interests can and must choose between them. (Id. at p. 210, 245 Cal.Rptr. 840.) Viewing the case in this way, the court was convinced that [it would] deprive [the conservatee] of a fundamental right were it to bar the conservator from withholding treatment. (Id. at p. 208, 245 Cal.Rptr. 840.) The court candidly acknowledged that to claim [a permanently unconscious conservatee's] `right to choose' survives incompetence is a legal fiction at best. (Ibid.) Indeed, such a person's noncognitive state prevents him from choosing anything. (Ibid.) Nevertheless, the court concluded, incompetence does not cause the loss of a fundamental right from which the incompetent person can still benefit through its vicarious exercise by a conservator. (Ibid.) As precedent for this analysis, the Drabick court relied on Conservatorship of Valerie N. (1985) 40 Cal.3d 143, 219 Cal.Rptr. 387, 707 P.2d 760, in which this court held unconstitutional a statute (§ 2356, subd. (d)) barring use of the conservator's statutory powers to authorize sterilization of wards and conservatees. Just as this court in Valerie N. permitted conservators of developmentally disabled women to exercise vicariously their conservatees' right to choose sterilization, the Drabick court explained, the conservator of a persistently vegetative conservatee may exercise vicariously the conservatee's right to refuse medical treatment. ( Drabick, supra, at pp. 207-208, 245 Cal.Rptr. 840.) [9] Having expressly recognized the fiction[al] aspect of its analysis ( Drabick, supra, 200 Cal.App.3d 185, 208, 245 Cal.Rptr. 840), and seeking perhaps to place its conclusion on firmer ground, the court in Drabick offered this alternative rationale: In the years since the [Matter of] Quinlan [(1976) 70 N.J. 10, 355 A.2d 647] decision, the Drabick court wrote, most courts have adopted the formula that a patient's `right to choose' or `right to refuse' medical treatment survives incompetence. It would be more accurate to say that incompetent patients retain the right to have appropriate medical decisions made on their behalf. An appropriate medical decision is one that is made in the patient's best interests, as opposed to the interests of the hospital, the physicians, the legal system, or someone else. (Id. at p. 205, 245 Cal.Rptr. 840.) We do not question the Drabick court's conclusion that incompetent persons have a right, based in the California Constitution, to appropriate medical decisions that reflect their own interests and values. ( Drabick, supra, at p. 205, 245 Cal.Rptr. 840.) But the right to an appropriate decision by a court-appointed conservator does not necessarily equate with the conservatee's right to refuse treatment, or obviously take precedence over the conservatee's right to life or the state's interest in preserving life. No published decision in this state has rejected the Drabick court's conclusions. Seven months after Drabick, the court in Conservatorship of Morrison (1988) 206 Cal.App.3d 304, 308-309, 253 Cal.Rptr. 530, viewed Drabick as having settled the question whether former section 2355 empowered a conservator to end the life of a persistently vegetative conservatee by withholding artificial nutrition and hydration. But neither, until the decision presently on review, has the holding in Drabick been extended to cases involving conservatees other than those in persistent vegetative states. This, almost certainly, is because the Drabick court strictly limited its decision to such persons. The opinion's reasoning, the court wrote, is predicated upon its subject being a patient for whom there is no reasonable hope of a return to cognitive life. We have not considered any other case, and this opinion would not support a decision to forego treatment if this factual predicate could not be satisfied. ( Drabick, supra, 200 Cal.App.3d 185, 217, fn. 36, 245 Cal.Rptr. 840.) Although the court did not explain how its reasoning was predicated on the conservatee's permanently unconscious state, the decision's self-imposed limitation avoids or mitigates a serious constitutional problem: A person whose permanent unconsciousness prevents him from perceiving that artificial hydration and nutrition are being withdrawn arguably has a more attenuated interest in avoiding that result than a person who may consciously perceive the effects of dehydration and starvation.
The ultimate focus of our analysis, as mentioned at the outset, must be section 2355, the statute under which the conservator claims the authority to end the conservatee's life. The statute's history indicates that the Law Revision Commission, which drafted the current version, was aware of and intended to incorporate some, but not all, of the Drabick, supra, 200 Cal.App.3d 185, 245 Cal.Rptr. 840 court's construction of the former statute. As originally enacted in 1979, and at the time the lower courts ruled in this case, section 2355 provided: If the conservatee has been adjudicated to lack the capacity to give informed consent for medical treatment, the conservator has the exclusive authority to give consent for such medical treatment to be performed on the conservatee as the conservator in good faith based on medical advice determines to be necessary and the conservator may require the conservatee to receive such medical treatment, whether or not the conservatee objects. (Former § 2355, subd. (a), added by Stats.1979, ch. 726, § 3, pp. 2379-2380, repealed and reenacted without change by Stats.1990, ch. 79, § 14, p. 575 [enacting new Probate Code].) This language arguably was broad enough to cover the entire range of medical decisions a conservator might be called upon to make. Historical evidence is lacking, however, that the Legislature in 1979 actually contemplated that the statute would be understood as authorizing a conservator to deliberately end the life of a conservatee by withholding artificially delivered food and water. Such authority, if it indeed existed, would have been merely implicit, as a consequence of the statute's broad language. The claim that section 2355 conferred that authority was first considered and accepted in 1988 by the court in Drabick, supra, 200 Cal.App.3d 185, 245 Cal.Rptr. 840. (See ante, 110 Cal.Rptr.2d p. 424, 28 P.3d p. 161 et seq.) The Drabick court also read former section 2355 as severely restricting the role of courts in supervising conservators' treatment decisions. [W]e do not believe, the court wrote, that it is the [trial] court's role to substitute its judgment for the conservator's. Instead, when the conservator or another interested person has requested the court's approval the court should confine its involvement to ensuring that the conservator has made the type of decision for which the Probate Code expressly calls: a `good faith' decision `based on medical advice' whether treatment is `necessary.' ( Drabick, supra, 200 Cal. App.3d 185, 200, 245 Cal.Rptr. 840, quoting former § 2355.) The required decision, the court explained, is the conservator's assessment of the conservatee's best interests. While acknowledging that the conservator would be bound by the conservatee's formal health care directions in a durable power of attorney or living will ( Drabick, supra, at p. 211, fn. 28, 245 Cal.Rptr. 840), the court rejected the different idea . . . that [the conservatee's] own prior informal statements compel either the continuation or cessation of treatment in a particular case. (Id. at p. 210, 245 Cal.Rptr. 840, first italics added.) Instead, the conservatee's prior statements [merely] inform the decision of the conservator, who must vicariously exercise the conservatee's rights. Such statements do not in themselves amount to the exercise of a right. The statute gives the conservator the exclusive authority to exercise the conservatee's rights, and it is the conservator who must make the final treatment decision regardless of how much or how little information about the conservatee's preferences is available. There is no necessity or authority, the court concluded, for adopting a rule to the effect that the conservatee's desire to have medical treatment withdrawn must be proved by clear and convincing evidence or another standard. Acknowledging that the patient's expressed preferences are relevant, it is enough for the conservator, who must act in the conservatee's best interests, to consider them in good faith. (Id. at pp. 211 212, 245 Cal.Rptr. 840, fn. omitted.) In 1990, the Legislature repealed and reenaeted former section 2355 without change while reorganizing the Probate Code. But in 1999, section 2355 changed significantly with the Legislature's adoption of the Health Care Decisions Law (§ 4600 et seq., added by Stats.1999, ch. 658). That law took effect on July 1, 2000, about four months after the Court of Appeal filed the opinion on review. Many of the new law's provisions, as already noted, are the same as, or drawn from, the Uniform Health-Care Decisions Act. (See 30 Cal. Law Revision Com. Rep., supra, p. 49.) Section 2355, as a statute addressing medical treatment decisions, was revised to conform to the new law. The main purpose of the Health Care Decisions Law is to provide procedures and standards governing health care decisions to be made for adults at a time when they are incapable of making decisions on their own and [to] provide[ ] mechanisms for directing their health care in anticipation of a time when they may become incapacitated. (30 Cal. Law Revision Com. Rep., supra, p. 6.) The core provision of the new law, which comes directly from the Uniform Health-Care Decisions Act, sets out uniform standards for the making of health care decisions by third parties. The language embodying this core provision now appears in statutes governing decisions by conservators (§ 2355), agents (§ 4684), and surrogates (§ 4714). This language is set out below in italics, as it appears in the context of section 2355: If the conservatee has been adjudicated to lack the capacity to make health care decisions, the conservator has the exclusive authority to make health care decisions for the conservatee that the conservator in good faith based on medical advice determines to be necessary. The conservator shall make health care decisions for the conservatee in accordance with the conservatee's individual health care instructions, if any, and other wishes to the extent known to the conservator. Otherwise, the conservator shall make the decision in accordance with the conservator's determination of the conservatee's best interest. In determining the conservatee's best interest, the conservator shall consider the conservatee's personal values to the extent known to the conservator. The conservator may require the conservatee to receive the health care, whether or not the conservatee objects. In this case, the health care decision of the conservator alone is sufficient and no person is liable because the health care is administered to the conservatee without the conservatee's consent. For the purposes of this subdivision, `health care' and `health care decision' have the meanings provided in Sections 4615 and 4617, respectively. (§ 2355, subd. (a), as amended by Stats.1999, ch. 658, § 12, italics added.) The last sentence of section 2355, subdivision (a), set out above, incorporates definitional provisions of the Health Care Decisions Law. Of these, section 4615 defines `[h]ealth care' as any care, treatment, service, or procedure to maintain, diagnose, or otherwise affect a patient's physical or mental condition. Section 4617 defines `[h]ealth care decision' as a decision made by a patient or the patient's agent, conservator, or surrogate, regarding the patient's health care, including the following: [¶] (a) Selection and discharge of health care providers and institutions. [¶] (b) Approval or disapproval of diagnostic tests, surgical procedures, and programs of medication. [¶] (c) Directions to provide, withhold, or withdraw artificial nutrition and hydration and all other forms of health care, including cardiopulmonary resuscitation. (Italics added.) These revisions to section 2355, like the remainder of the Health Care Decisions Law, were drafted by the Law Revision Commission. In its official comment to section 2355, the commission wrote that subdivision (a), as amended, is consistent with . . . Drabick, [ supra, 200] Cal.App.3d 185 [245 Cal.Rptr. 840]. . . . (30 Cal. Law Revision Com. Rep., supra, com. to § 2355, p. 263.) In the comment, the commission also set out important passages from the Drabick opinion, presumably as indicative of the drafters' intent. Indeed, the new law is consistent with Drabick in recognizing the power of conservators to refuse consent to health care, even health care necessary to sustain life, and in treating the decision to withhold artificial nutrition and hydration as a health care decision. In other respects, the current version of section 2355 departs from the decision in Drabick, supra, 200 Cal.App.3d 185, 245 Cal.Rptr. 840. The Drabick court viewed the informally expressed wishes of the incompetent conservatee simply as a factor for the conservator to consider in determining the conservatee's best interest. (Id. at pp. 211-212, 245 Cal.Rptr. 840.) In contrast to Drabick, section 2355 assigns dispositive weight to the conservatee's informally expressed wishes, when known. Under the statute, [t]he conservator shall make health care decisions for the conservatee in accordance with the conservatee's individual health care instructions, if any, and other wishes to the extent known to the conservator. (§ 2355, subd. (a).) The best interest standard applies only when the conservatee's wishes are not known, as a fallback standard embodied in the statute's next sentence: Otherwise, the conservator shall make the decision in accordance with the conservator's determination of the conservatee's best interest. In determining the conservatee's best interest, the conservator shall consider the conservatee's personal values to the extent known to the conservator. (Ibid.)