In the Matter of O’Connor, 72 N.Y.2d 517 (1988)

To decline life-sustaining medical treatment, an incompetent patient’s prior expressed wishes must be proven by clear and convincing evidence that the patient held a firm and settled commitment to decline the treatment under circumstances similar to those presented.

Summary

This case concerns Mary O’Connor, an elderly, incompetent hospital patient who previously expressed a desire not to be kept alive by artificial means if she could not care for herself. When the hospital sought court authorization to insert a nasogastric tube for feeding, her daughters objected, citing her prior statements. The New York Court of Appeals reversed the lower courts’ denial of the hospital’s petition, holding that there was not clear and convincing proof of a firm and settled commitment by O’Connor to decline this type of medical assistance under the current circumstances. The court emphasized the need for unequivocal proof when terminating life support is at issue.

Facts

Mary O’Connor, a 77-year-old widow with a history of working in hospital administration, suffered several strokes that left her mentally incompetent and physically unable to care for herself. Prior to her incompetency, she made statements that she did not want to be a burden and would not want to be kept alive artificially if she could not care for herself. After being cared for at home by her daughters and eventually placed in a long-term care facility, she suffered another stroke rendering her unable to swallow. The hospital sought to insert a nasogastric tube for feeding after intravenous feeding proved inadequate, but her daughters objected, citing her prior wishes.

Procedural History

The hospital petitioned the trial court for authorization to insert a nasogastric tube. The trial court denied the petition, concluding it was contrary to O’Connor’s wishes. The Appellate Division affirmed. The New York Court of Appeals granted leave to appeal and issued a stay, allowing intravenous feeding to continue pending the appeal.

Issue(s)

Whether there was clear and convincing evidence that Mary O’Connor, while competent, made a firm and settled commitment to decline the insertion of a nasogastric tube for feeding under her current circumstances, where she is elderly, disabled, but not terminally ill, comatose, or in a vegetative state.

Holding

No, because the evidence presented did not meet the demanding standard of clear and convincing proof that Mrs. O’Connor had a firm and settled commitment to decline the nasogastric tube under these specific circumstances.

Court’s Reasoning

The court reaffirmed the common-law right to decline medical treatment, even life-saving treatment, absent an overriding state interest, citing Schloendorff v. Society of N. Y. Hosp. The court also referenced Matter of Storar and Matter of Eichner v. Dillon, emphasizing that a hospital must respect this right even when a patient becomes incompetent if, while competent, the patient expressed their wishes. The court stressed that the standard of proof required to decline life-sustaining treatment is “clear and convincing evidence,” because “nothing less than unequivocal proof will suffice when the decision to terminate life supports is at issue.” The court found that Mrs. O’Connor’s statements, while repeated over time, were general expressions of a desire not to be a burden and to avoid prolonged suffering, not a specific rejection of medical assistance for nutrition under her current condition. The court distinguished this situation from cases where the patient had a terminal illness or was in a coma or vegetative state. The court noted the importance of considering the circumstances in which the statements were made and comparing them with those presently prevailing. The court stated, “Every person has a right to life, and no one should be denied essential medical care unless the evidence clearly and convincingly shows that the patient intended to decline the treatment under some particular circumstances.” Even the daughters admitted they did not know what their mother would want under these circumstances. The court found that Mrs. O’Connor’s prior statements did not demonstrate a firm and settled commitment to decline medical assistance when her prognosis was uncertain, and her only change in condition was the loss of her gag reflex, requiring medical assistance to eat. The court also stated that waivers of constitutional rights are always carefully scrutinized by the courts, and no one’s request to have real or personal property pass to a specified person upon death can be enforced in court unless it is also expressly stated in a signed will.