Court Opinion

ID: 9648885
Source: CourtListenerOpinion
Date Created: 2023-08-23 14:37:21.750215+00
Date Added: 2024-06-11T09:08:15.366420
License: Public Domain

CLIFFORD, Justice,
with whom ROBERTS and WATHEN, JJ., join, dissenting.
I respectfully dissent.
I agree that the evidence supports the finding of the Superior Court as to Joseph Gardner’s persistent, vegetative and incog-nitive condition.
I do not agree that the Superior Court’s finding that Gardner would want the naso-gastric feeding and hydration tube removed is based on sufficiently clear and convincing evidence so as to constitute an informed refusal. Moreover, this Court has failed to properly assess and balance the right to refuse life-sustaining procedures and the state’s legitimate interest in preserving life and preventing suicide.
*957I.
This Court grounds its decision on the right to refuse medical treatment and determines that right to be firmly anchored in the common law doctrine of informed consent. 534 A.2d at 951. Before a consent to undergo medical treatment can be said to be “informed,” a patient must be provided with sufficient information to enable the patient to understand the procedures and inherent risks and hazards involved in the treatment. Downer v. Veilleux, 322 A.2d 82, 90-91 (Me.1974); 24 M.R.S.A. § 2905 (Supp.1987). In view of the strong public policy in favor of preserving life, see In re Conroy, 98 N.J. 321, 486 A.2d 1209, 1233 (1985), the decision to refuse medical treatment, especially where certain death will result, should be at least as informed as the decision to consent to treatment.
There is no evidence that Joseph Gardner ever expressed his wishes in writing or orally as to specific circumstances under which he wished life-sustaining measures to be discontinued, and the Superior Court acknowledged that the conversations of Gardner upon which it relied were “casual and of a general nature rather than about specific cases.” The court relied in large measure upon Gardner’s active life-style in finding that he would want the feeding tube removed. That type of evidence, if offered to support a decision of informed consent, would be woefully inadequate. It is all the more inadequate to support a refusal that will result in certain death. In the present case there is no basis for concluding that Joseph Gardner’s refusal is informed.
II.
Even if the evidence did support the trial court’s determination of Joseph Gardner’s intent, I would not affirm the judgment. I do not dispute this Court’s holding that a person has a substantial right to refuse medical treatment, including life-sustaining medical procedures. That right, however, is not absolute and must be measured against the interests of the state in requiring that certain medical procedures be undertaken or in insuring that certain treatment is not withdrawn. Superintendent of Belchertown State School v. Saikewicz, 373 Mass. 728, 370 N.E.2d 417, 425 (1977).
Those state interests are a) the preservation of life, b) the protection of the interests of third parties,1 c) the prevention of suicide and d) maintaining the ethical integrity of the medical profession.2 Id.
The state has an interest in preserving the life of Joseph Gardner as an individual and in preserving life in general. Conroy, 486 A.2d at 1223. This interest in preserving life derives from our instinct for self-preservation and is essential to our survival as a civilization. That we protect the lives of the weakest and most vulnerable of our society shows us to be a humane and caring society. See 42 U.S.C.A. §§ 5101-5103 (1983 & Supp.1987); 22 M.R.S.A. §§ 3470-3478 (Supp.1987). Likewise, the state’s interest in preventing suicide has long been recognized and is reflected in our criminal code. 17-A M.R.S.A. §§ 106(6),3 201(1)(C),4 204.5 See In re Caulk, 125 N.H. 226, 480 A.2d 93, 96-97 (1984).
*958Before the withdrawal of any life-sustaining treatment can be sanctioned, there should be a balancing of the right of the patient to refuse the procedures against the interest of the state in the procedures being continued. In my judgment, this Court has not engaged in a proper balancing and has not properly focused on the patient’s intention to refuse medical treatment.
The right to refuse life-sustaining procedures should be respected if the refusal is based on the nature of the procedures, i.e., that they are invasive or painful or produce risks or are of minimum benefit to the patient. Saikewicz, 370 N.E.2d at 431-32. To the extent that the Superior Court addressed the use of the nasogastric tube involved in this case, the procedure was shown to be minimally invasive, causing no pain nor risk of any disease or infection, yet sustaining Joseph Gardner with nutrients and water.
We are not faced with a request to withdraw treatment because it is unnecessarily invasive or detrimental to the patient. Rather, the guardian has requested simply that Joseph Gardner “be permitted to die.” The Superior Court repeatedly referred to evidence of Joseph Gardner’s statements of not wanting to live in a vegetative state, and concluded that he would “want to die.” The Superior Court implicitly found that the quality of Joseph Gardner’s life is poor and granted to others the right to end his life. By affirming the Superior Court, this Court ignores the legitimate interest our society has in preventing such decisions from being based on the quality of life.
This Court suggests that death will come from the inability of Joseph Gardner to swallow, a result of the tragic accident, and that “[fjorcing upon him the life-sustaining procedures he has decided to refuse would only prolong the ultimate moment of his death.” 534 A.2d at 956. But Joseph Gardner is not terminally ill and if the feeding tube is withdrawn, he will starve to death. Drawing a chain of proximate causation from the accident to his death does not lessen the impact of this stark result. The outcome in such a case should not turn on whether the patient has the capacity to swallow, to lift his head, or to sip from a cup.
The Maine Legislature has treated nutrition and hydration differently than other medical or life-sustaining procedures. Nutrition and hydration may not be withdrawn under 22 M.R.S.A. §§ 2921-2931 (Supp.1987), the Maine Living Wills Act, even though the patient has formally executed a will requesting withdrawal. 22 M.R.S.A. § 2921(4). Indeed, no life-sustaining treatment may be withheld or withdrawn under the Act except from a terminally ill patient. 22 M.R.S.A. § 2922(3)(B). This legislative enactment reflects the value placed on life and the significance of food and water to our survival.
We need not decide if nutrition and hydration must always be treated differently than other medical or life-sustaining procedures. Here, however, where food and water are being provided in a non-invasive, pain-free manner to a non-terminally ill patient, the withdrawal of such a feeding tube for the purpose of causing his death ignores the legitimate and longstanding interest of the state in preserving life and preventing suicide, exposes many members of our society to potential abuse, and should not be sanctioned.
Our status as a civilized society is significantly discredited when we abdicate our responsibility to care for those who are unable to care for themselves. The provision of sustenance to the most vulnerable among us serves as a binding value in our society and is an obligation we cannot ignore. This Court’s decision, premised on the unarticulated notion that Joseph Gardner’s life is not worth maintaining, creates a troubling precedent. Those in our society least able to care for themselves, the disabled, the retarded, the elderly, will not fare well under a quality of life assessment, implicitly used here.
The authorities relied upon by this Court are contrary to values expressed by our legislature and essential to our survival as a caring society. They do not persuade me that the Superior Court judgment should be affirmed. See Comment, Maine’s Liv*959ing Will Act and the Termination of Life Sustaining Medical Procedures, 39 Me.L. Rev. 83 (1987).
I would vacate the judgment.

. For example, it is common for states to require immunization of students in the interest of public health. See 20-A M.R.S.A. §§ 6352-6359 (Supp.1987). See also 534 A.2d at 953 n. 5.

. Because this Court upholds the right of health care providers and personnel to refuse to participate in the withdrawal of life-sustaining procedures, that state interest is not directly implicated here.

. 17-A M.R.S.A. § 106(6) (1983) provides:
A person acting under a reasonable belief that another person is about to commit suicide or to inflict serious bodily injury upon himself may use a degree of force on such person as he reasonably believes to be necessary to thwart such a result.

.17-A M.R.S.A. § 201(1)(C) (1983) provides:
1. A person is guilty of murder if:
C. He intentionally or knowingly causes another human being to commit suicide by the use of force, duress or deception.

. 17-A M.R.S.A. § 204 (1983) provides:
§ 204. Aiding or soliciting suicide
1. A person is guilty of aiding or soliciting suicide if he intentionally aids or solicits another to commit suicide, and the other commits or attempts suicide.
2. Aiding or soliciting suicide is a Class D crime.