Court Opinion

ID: 9745913
Source: CourtListenerOpinion
Date Created: 2023-08-27 13:42:14.349543+00
Date Added: 2024-06-11T12:25:51.966448
License: Public Domain

RAYE, J.,
JConcurring.—As the majority correctly explains, a conservatee whose right to live may ultimately hinge on decisions made by his court-appointed conservator is entitled to counsel to represent his interests. I concur fully in the majority’s reasoning. I write separately to emphasize the complexity of the life and death issues underlying this litigation, a complexity possibly lost on the trial court, which thought “the issues here after all is said and done are very simple.” Though I agree those issues are not ripe for resolution at this time, counsel appointed to represent the conservatee should not take our silence in addressing them as concurrence with the views expressed by the trial court. Quite simply, the issues are not simple.
This much is clear: A person has a constitutional right to refuse unwanted medical procedures, including artificial hydration and nutrition. (See Cruzan v. Director, Missouri Dept. of Health (1990) 497 U.S. 261, 277 [111 L.Ed.2d 224, 241, 110 S.Ct. 2841]; Thor v. Superior Court (1993) 5 Cal.4th 725 [21 Cal.Rptr.2d 357, 855 P.2d 375].)1 There is little doubt that if Robert were competent, he could refuse further medical treatment. However, in light of his incompetence and his failure to give advanced directives as to medical treatment or the choice of a surrogate decisionmaker, Robert’s freedom of choice “is a legal fiction at best.” (Conservatorship of Drabick (1988) 200 Cal.App.3d 185, 208 [245 Cal.Rptr. 840].) Instead, the court must select a conservator who has broad authority to make decisions regarding treatment, guided by the patient’s best interests.2 (Conservatorship of Drabick, supra, 200 Cal.App.3d at p. 212). The conservator is not bound by the conservatee’s prior informal expressions of intent.3 (Conservatorship of Drabick, supra, 200 Cal.App.3d at pp. 210-211.) A decision regarding the removal of Robert’s nasogastric tube does not hinge on judicial efforts to divine his unarticulated wishes regarding medical treatment. Counsel’s task is thus not *54simply to choose up sides between his wife, who believes he would not want to continue living, and the rest of his family who feel otherwise.4
The authority of a conservator to direct the withdrawal of nutrition and hydration from a patient in a persistent vegetative state has been considered by courts in California and elsewhere. (See Conservatorship of Drabick, supra, 200 Cal.App.3d 185, and cases collected in Note, The Limits of the Autonomy Principle: Refusal of Life-Sustaining Medical Treatment for Incompetent Persons, supra, 22 Hofstra L.Rev. at p. 707.) The conservator of a patient in a persistent vegetative state may properly order the cessation of artificial hydration and nutrition if the patient’s best interests would be served by such a course of action. Cases upholding such authority reflect ethical judgments based on scientific knowledge regarding the quality of life of such persons and the consequences of withdrawing water and nutrition.5 A person in a persistent vegetative state has no chance of recovery and is oblivious to his or her surroundings.6 Such patients “ ‘do not have the capacity to experience pain or suffering. Pain and suffering are attributes of consciousness requiring cerebral cortical functioning, and patients who are permanently and completely unconscious cannot experience these symptoms.’ ” (Comment, Life in Limbo: Revising Policies for Permanently Unconscious Patients, supra, 31 Hous. L.Rev. at p. 1638.) The withdrawal of water and nutrition from a permanently unconscious patient does not have the same consequences it would have for a person with even limited cognitive functions. As discussed in the principal opinion, Robert is apparently not in a persistent vegetative state (PVS). Whether the principles developed in cases involving PVS patients apply to the present case remain to be seen, suggestions by the trial court to the contrary notwithstanding. Nothing in our opinion should be taken as expressing an opinion on that question.

 the implications of the Cruzan decision generally, see Eaton and Larson, Experimenting With the “Right to Die" in the Laboratory of the States (1991) 25 Ga. L.Rev. 1253.

Arguably, the constitutional right cannot be exercised by another. As one writer suggests, “A liberty interest is by definition an interest in doing as one chooses rather than as someone else would choose. Therefore it is not sensible to speak of a liberty interest as being exercised where someone else is choosing in the rightholder’s stead.” (Note, The Limits of the Autonomy Principle: Refusal of Life-Sustaining Medical Treatment for Incompetent Persons (1994) 22 Hofstra L.Rev. 703, 707.)

 On standards for surrogate decisionmaking, see Comment, Life in Limbo: Revising Policies for Permanently Unconscious Patients (1995) 31 Hous. L.Rev. 1609; Comment, Letting Daddy Die: Adopting New Standards for Surrogate Decisionmaking (1992) 39 UCLA L.Rev. 581.

“The family of an incompetent person should not be empowered with a govemmentally granted ‘right’ to decide for the incompetent person because they are likely to have the best idea of what the incompetent person would do if he were competent.” (Note, The Limits of the Autonomy Principle: Refusal of Life-Sustaining Medical Treatment for Incompetent Persons, supra, 22 Hofstra L.Rev. at p. 707.)

See Bleich, Moral Debate and Semantic Sleight of Hand (1993) 27 Suffolk U. L.Rev. 1173.

The vegetative state has been defined as “a clinical condition of complete unawareness of the self and the environment, accompanied by sleep-wake cycles with either complete or partial preservation of hypothalamic and brain- stem autonomic functions.” (The Multi-Society Task Force on PVS, Medical Aspects of the Persistent Vegetative State, Pt. 1 (1994) 330 New Eng. J.Med. 1499, 1503.)