aka Spahn vs Eisenburg
- Excerpt from memo sent to UWHC Medical Faculty, House Officers, Nursing Leadership Group, and Senior Administration from Norm Fost and Robert Miller on June 16, 1997 regarding Wisconsin Supreme Court Decision Concerning Life Support Decisions:
- On June 12, 1997, the Wisconsin Supreme Court issued a surprising decision In the Matter of the Guardianship and Protective Placement of Edna M.F. The court ruled that a court-appointed legal guardian of a ward can authorize withholding or withdrawing life support only when (1) the ward has been diagnosed as being in a permanent vegetative state or (2) the ward has a prior advance directive or other clear instructions indicating that life support should not be used. The court further ruled that a Wisconsin court order can not expand this authority of a legal guardian to other situations. This is one of the most restrictive interpretations of guardian and judicial power in the country.
- It is important to note what this court decision does not address. It does not address the situation where there is no legal guardian. Therefore, when the patient, spouse, parents, next of kin or health care agent are making the treatment decision, this court decision does not apply and existing hospital policies and guidelines should be consulted.
- The story behind the court case:
- Edna M.F. was a 73 year old woman with advanced Alzheimer's dementia who was residing in a Wisconsin nursing home. She was bedridden in a fetal position; incontinent; unable to eat, move, or follow simple commands; and was without prospect for improvement.
- Edna's health-care providers, her guardian ad litem, and her family members supported her legal guardian's good faith determination that treatment termination (removal of feeding tube) would be in Edna's best interests.
- The facility's ethics committee met to consider the guardian's request to withdraw tube feedings, and decided while it was ethically appropriate, the facility must secure written consent from all of Edna's potential heirs.
- All of Edna's family members consented to the withdrawal of the artificial nutrition, but one niece refused to document her assent in writing.
- The circuit court, and later WI Supreme Court, ruled that the guardian could not consent to withdrawal because the ward had not made a clear enough statement prior to incompetency of her desires.
- Ironically, Edna was determined to be in a persistent vegetative state in October of 1997 and care was allowed to be withdrawn. She died in November of 1997.
- A guardian must follow the following procedures:
- Notice of the decision to withhold or terminate life sustaining treatment must be given to any "interested parties", including: the ward; the ward's spouse; next of kin; close friend or associate over a significant period of time; the ward's physician and facility/agency where the individual is receiving his or her medical care; the individual's guardian ad litem, if any; an agent under a health care power of attorney; and any official or representative of a public or private agency, corporation or association with the ward's welfare.
- If none if the above interested parties objects, the guardian may make the decision without a court hearing
- If an interested party objects, the court will presume that continued life is in the best interests of the ward, and the burden will rest on the guardian to show both the existence of a persistent vegetative stat to a high degree of medical certainty and that the decision to withhold or withdraw treatment is in the ward's best interests and is being made in good faith.
Wisconsin Supreme Court Opinion
Hughes, M.: A Guardian's Authority to Consent to the Withholding or Withdrawal of Life Sustaining Treatment From His or Her Ward, CWAG, May 2000
Shapiro, R.: In Re Edna MF: Case Law Confusion in Surrogate Decision Making, Theoretical Medicine, 20: 45-54, 1999.