Couture v. Couture
| Decision Date | 21 August 1989 |
| Docket Number | Nos. CA,s. CA |
| Citation | 549 N.E.2d 571,48 Ohio App.3d 208 |
| Parties | COUTURE, Appellant and Cross-Appellee, v. COUTURE et al., Appellees; Miami Valley Hospital, Appellee and Cross-Appellant. 11677, CA 11678 and CA 11679. |
| Court | Ohio Court of Appeals |
Syllabus by the Court
The public policy of this state, as announced by the General Assembly in its enactment of R.C. 1337.11 through 1337.17, forbids the withdrawal of hydration or nutrition from a comatose patient in a persistent vegetative state with no realistic prospect of recovery, where the withdrawal of nutrition or hydration is likely to result in the death of the patient. Such withdrawal is prohibited notwithstanding previous oral statements of the patient himself that he would not desire the use of artificial life support to prolong his existence.
Patrick J. Foley, Dayton, for appellant and cross-appellee Clarence Couture, Jr.
Carol A. Stefanich and Thomas Baggott, Dayton, for appellee Bertha J. Couture.
Dale Creech, Jr., Dayton, for appellee and cross-appellant Miami Valley Hosp.
Daryl R. Douple, Dayton, guardian ad litem, for Daniel Couture.
This matter comes on appeal from the Probate Division of the Montgomery County Court of Common Pleas. For reasons more fully explained below, we find that the order of that court should be modified to prohibit the withdrawal of nutrition and hydration from the program of health care provided to Daniel Lloyd Couture.
On April 20, 1989, twenty-nine-year-old Daniel Lloyd Couture went into a coma, allegedly as a result of a medicine he received. He has been a patient at Miami Valley Hospital in Dayton, Ohio and has remained comatose since that date. Initially, Daniel was sustained by a respirator and received nourishment and hydration (water) through a feeding tube. The respirator has now been removed and Daniel is breathing on his own.
Both Clarence and Bertha Couture (Daniel's divorced parents) filed applications to be appointed guardian of Daniel by reason of his disability. A guardianship hearing before the probate court took place on May 30 at which both applicants testified. At the conclusion of the hearing, the probate court appointed Bertha Couture Daniel's guardian.
At the time of her appointment Bertha Couture testified that it would be in the best interests of Daniel Couture to terminate use of the respirator and intertubal nutrition and hydration. Her position was taken with the advice and guidance of Daniel's physician and the agreement of other family members. Clarence Couture objected and instituted legal proceedings in several forms to oppose and prevent the proposed withdrawal.
On June 15, Clarence Couture filed a motion to remove Bertha Couture as guardian; a motion for a temporary restraining order and for a preliminary injunction preventing Bertha Couture, Miami Valley Hospital, Dr. Stephen Frank, and the state of Ohio from removing any life support system from Daniel; and a complaint for injunctive relief enjoining the above-mentioned defendants from removing any life support system along with a request for declaratory judgment of the rights of Daniel Couture. The probate court issued a temporary restraining order the following day, to remain in effect until June 28.
A hearing before the probate court took place on June 26. The court heard evidence from Bertha Couture and her son, James, in support of the view that Daniel opposed the use of life-prolonging medical care in these circumstances. It also heard testimony from physicians concerning Daniel's illness and prognosis. The probate court overruled Clarence Couture's motion seeking to have Bertha Couture removed as guardian. The court denied Clarence Couture's request for injunctive and declaratory relief. In its June 27 entry, the court also stated:
" * * * Bertha J. Couture, as such Guardian, is entitled to make those decisions for further treatment and care, after consulting with the ward's doctors, and which would be best for the ward and in accordance with the desires of the ward."
The court stated that the temporary restraining order previously issued would remain in effect until June 28.
On June 28, Clarence Couture filed three notices of appeal to this court. Case No. CA 11677 represents his appeal from the probate court's May 30 final judgment and order appointing Bertha Couture as guardian of Daniel. Case No. CA 11678 represents Clarence Couture's appeal from the probate court's June 27 order overruling his motion to remove Bertha Couture as guardian. Case No. 11679 represents Clarence Couture's appeal from the probate court's June 27 order denying his request for preliminary and permanent injunctions; denying his request for injunctive and declaratory relief; entitling Mrs. Couture to make those decisions for further treatment and care of Daniel, after consulting with his doctors, which would be best for Daniel and in accordance with his desires; and allowing the temporary restraining order to expire on June 28.
On June 28, this court issued an order restraining the defendants from removing any life support system pending further court order. (The order did not, however, prohibit attempts dictated by acceptable medical standards to wean Daniel from the respirator.) On June 30, and after having heard evidence and arguments presented in open court, this court sustained Clarence Couture's motion for an injunction pending appeal. Oral argument was initially scheduled for July 31, but was later postponed until August 14, 1989, on the joint application of Clarence Couture and the hospital, without opposition by Bertha Couture.
On July 10, and upon a motion of Clarence Couture, this court ordered Case Nos. CA 11677, CA 11678, and CA 11679 consolidated.
On July 27, Miami Valley Hospital filed a notice of appeal from the probate court's June 27 order.
On August 2, 1989, Bertha Couture voluntarily withdrew as guardian, and Clarence Couture was appointed guardian of Daniel Lloyd Couture.
This matter was heard by this court in oral argument on August 14, 1989. Arguments were heard from counsel on behalf of Clarence Couture and for Bertha Couture and Miami Valley Hospital. A guardian ad litem appointed for Daniel Couture submitted his argument by brief.
It is undisputed that Daniel Couture, who has been in a coma since April 20, 1989, is in a persistent vegetative state with no medically recognized prospect of recovery. His probability of recovery has been described by medical authorities as of the lowest order. There is, according to medical opinion, virtually no possibility that he will regain useful function. Counsel for Bertha Couture and Miami Valley Hospital state Daniel's chances of recovery as between one in four hundred to one in one million, or less. Counsel for Clarence Couture concedes that it is the greatest possibility that Daniel is in an irreversible coma.
A persistent vegetative state is one in which the patient is awake but unconscious. He is unable to attend to or provide for any of his needs. He is unable to sense pain. All of Daniel's needs are being met by the medical and nursing staff of Miami Valley Hospital.
When this matter was first considered by the probate court, Daniel Couture was receiving breathing assistance from a mechanical respirator and water and nutrition through a feeding tube. He has since been weaned from the respirator but continues to receive hydration and nutrition in the same manner.
At the time of the hearing on June 26, medical experts testified that Daniel's bodily systems and organs continued to function. His underlying condition had, however, created fluid on the brain. Those fluids and the pressure on the brain from them would continue to grow until death occurs as a result of failure of some major bodily system. Expert opinion held that, with continued nutrition and hydration, Daniel would continue to live only one or two more months. Under these circumstances, medical ethics and procedure would permit withdrawal of nutrition and hydration.
The central and critical issue posed by this case is whether nutrition and hydration may be withdrawn prior to Daniel Couture's natural death. It has been the position of Bertha Couture that withdrawal is medically appropriate and consistent with Daniel's prior statements that he would not wish to be kept alive by artificial means. It has been the position of Miami Valley Hospital that, as withdrawal is consistent with sound medical practice and supported by the guardian and the majority of Daniel's family, the court should not prohibit it. Clarence Couture has opposed withdrawal, contending that it is inappropriate so long as Daniel remains alive.
Appellant Clarence Couture argues that the probate court erred in the appointment of Bertha Couture, and in its later refusal to remove her, because she expressed a willingness and intention to terminate life support systems. 1 In those proceedings, Clarence Couture asked that he be appointed in her place. He has taken the position that he will not terminate nutrition and hydration.
These issues have been rendered moot by the withdrawal of Bertha Couture and the appointment of Clarence Couture as guardian.
Appellant's assignments of error objecting to the appointment of Bertha Couture as guardian are overruled.
Appellant Clarence Couture's first and second assignments of error argue that the probate court erred in not enjoining the guardian and the hospital from withdrawing life-prolonging treatment and in not directing that it be continued. They raise the same issues and will be considered together.
Each party, father, mother, and hospital, 2 has presented arguments that are sincere, well-made, and well-supported. Each is motivated by a genuine and profound sense of responsibility to Daniel Couture...
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