Court Opinion

ID: 9676650
Source: CourtListenerOpinion
Date Created: 2023-08-24 05:29:29.891406+00
Date Added: 2024-06-11T18:16:49.904652
License: Public Domain

LAMBERT, Justice,
concurring.
While I concur with the result achieved by the majority, I write separately to express my reservations with respect to dictum in the opinion and the potential created for an erroneous application of the legal principles involved.
The result here is compelled by the evidence. Kentucky and virtually every common law jurisdiction have long recognized the principle that a person has a right to refuse medical treatment. Tabor v. Scobee, Ky., 254 S.W.2d 474 (1951). From the evidence presented and as found by the trial court, it appears that Ms. DeGrella had on numerous occasions expressed the firmly held view that her life should not be prolonged artificially and that the normal process of dying be permitted to occur. As such, it makes little difference in this case as to what legal standard is applied for the outcome would be the same.
I am deeply concerned,' however, that the majority opinion may be understood to authorize surrogate decision making or substituted judgment1 as a legal standard whereby the judgment of a close family member or other person would prevail as to what the patient would have wantéd even in the absence of a clear declaration of such by the patient. Such a standard is a significant step beyond merely allowing relatives, friends, medical personnel, or other credible sources, including writings, to report the wishes of the patient as expressed *711prior to the time of incompetence. While it is obvious that substituted judgment for the termination of medical treatment is rife with the potential for abuse, a more fundamental objection is that the perceived moral and ethical values of the patient may be lost or significantly influenced by the values of the surrogate. Moreover, there is a substantial danger that “quality of life” considerations may leak into the analytical process. As it is commonly understood, substituted judgment would likely be so subjective as to undermine any confidence that the patient’s wishes were being truly observed. We should declare in this case that neither family members nor doctors and certainly not judges possess the power to authorize cessation of medical treatment in the absence of clear and convincing evidence that the stricken person had (not would have) expressed the desire to avoid continuation of life in a persistent vegetative state.
While the majority has established “clear and convincing evidence” as the standard for decision making, I remain uncertain as to whether this standard applies to assessment of the patient’s medical condition or determining the patient’s wishes with respect to discontinuation of medical treatment. While the majority is correct in saying that the evidence here is clear and convincing with respect to both questions, we should state unmistakably that such evidence with respect to the patient’s wishes must be present whenever discontinuation of medical treatment is contemplated.
My greatest misgiving about the majority opinion is in what appears to be its amalgamation of the relevant concepts: (1) dispositive declarations prior to incompetence and (2) substituted judgment. The majority has said:
“Sue DeGrella’s statements of choice made before she became incompetent, while not dispositive of the question at hand, are competent evidence upon which a surrogate decision-maker could exercise substitute judgment in the circumstances presented.
“... In this Opinion we have recognized these rights [self-determination and informed consent] can be exercised by an incompetent person through the process of surrogate decision-making so long as the wishes of the patient are known.”
I regard the foregoing as contradictory or misleading as substituted judgment is unnecessary in circumstances as prevail here where the wishes of the patient are known and evidenced clearly and convincingly. True substituted judgment would be necessary, if lawful, only when the wishes of the patient were not clearly ascertainable.
Finally, the majority has sought to prevent litigation in cases of this type by declaring that:
“If the attending physician, the hospital or nursing home ethics committee where the patient resides, and the legal guardian or next of kin, all agree and document the patient’s wishes and the patient’s condition, and if no one disputes their decision, no court order is required to proceed to carry out the patient’s wishes. Future criminal sanctions or civil liability turn not on the existence or absence of a court order, but on the facts of the case.”
While I concur fully with this view, it must not be overlooked that all such persons are charged with the duty of rightly estimating the situation and upon failure to do so, may be held legally accountable. As this Court said in Bailey v. Commonwealth, 235 Ky. 173, 30 S.W.2d 879, 880 (1930), and reiterated in O’Leary v. Commonwealth, Ky., 441 S.W.2d 150, 155 (1969):
“It is firmly established by decisions of equal authority that a criminal law is not unconstitutional [or void for vagueness] merely because it throws upon people the risk of rightly estimating a matter of degree which deals with fixed and actual, as distinguished from imaginary and unascertained, conditions.”
The majority has accurately stated:
“[T]he court cannot absolve the parties from liability where the facts do not exist to support the action taken.”
Those who undertake to carry out the wishes of one in a persistent vegetative *712state should be admonished to exercise the utmost good faith and absolute obedience to the directions which have been given by the patient.

. At several places in the majority opinion, the phrase “substitute judgment” is utilized. In Guidelines for State Court Decision Making in Life-Sustaining Medical Treatment Cases, National Center for State Courts, 2nd ed., 187 (1992), this term is defined as follows:
“Substituted Judgment (standard): A legal standard for surrogate decisionmaking. By this standard, the surrogate makes the decision on the basis of what is known about the patient’s personal values and preferences. Compare best interest [standard]."