Lawrance, Matter of

• Decision Date: 16 September 1991
• Docket Number: No. 29S04-9106-CV-00460,29S04-9106-CV-00460
• Citation: 579 N.E.2d 32
• Parties: In the Matter of Sue Ann LAWRANCE, An Incompetent Adult.
• Court: Indiana Supreme Court

Page 32

579 N.E.2d 32

In the Matter of Sue Ann LAWRANCE, An Incompetent Adult.

No. 29S04-9106-CV-00460.

Supreme Court of Indiana.

Sept. 16, 1991.

James Bopp, Jr., Mary M. Nimz, Thomas J. Marzen, The National Legal Center For the Medically Dependent & Disabled, Inc., Indianapolis, for appellant.

John L. Egloff, Bryce H. Bennett, Jr., Riley Bennett & Egloff, Indianapolis, for appellees.

C. Alan Funk, West Lafayette, for Association For Retarded Citizens of the U.S., Ethics and Advocacy Task Force of the Nursing Home Action Group, and Medical Issues Task Force of the United Handicapped Federation, amici curiae.

Janice E. Kreuscher, Segal & Macey, Indianapolis, M. Rose Gasner Fenella Rouse, New York City, for Concern For Dying, Inc. and Soc. For the Right To Die, Inc., amici curiae.

Theodore Lockyear, James A. Kornblum, Lockyear & Kornblum, Evansville, Joseph L. Bianculli, Washington, D.C., for The Hillhaven Corp., amicus curiae.

Myra C. Selby, L. Alan Whaley, Terri A. Czajka, Ice Miller Donadio & Ryan, Indianapolis, for Indiana Civ. Liberties Union, amicus curiae.

Paul R. Black, Indianapolis, for Indiana Health Care Ass'n, amicus curiae.

Thomas P. Monaghan, Walter M. Weber, Free Speech Advocates, New Hope, Ky., John J. Potts, School of Law, Valparaiso, Thomas A. Appel, Lansing, Ill., for Indiana Rights to Life, Inc., The Catholic League for Religious and Civil Rights, amici curiae.

C. William Ullrich, Constance J. Dinn, Indiana State Bd. of Health, Indianapolis, Linley E. Pearson, Harry John Watson, Office of Atty. Gen., Indianapolis, for The Indiana State Bd. of Health, amicus curiae.

Ronald L. Dyer, Indiana State Medical Ass'n, Indianapolis, for Indiana State Medical Ass'n, amicus curiae.

Michael V. Gooch, Sharon D. Elvidge, Grace M. Buechlein, Harrison & Moberly, Indianapolis, for The Manor House at Riverview, amicus curiae.

Eric I. Miller, Miller & Waters, Indianapolis, for Donald T. Nelson and Jesse Villalpando, Indiana State Representatives, amici curiae.

Kenneth M. Stroud, Indianapolis, for Kenneth M. Stroud, Professor of Law, Indiana University School of Law-Indianapolis, amicus curiae.

Donna Bays-Beinart, Dutton & Overman, Kenneth C. Kern, Indianapolis, for Unitarian Universalist Fellowship For Social Justice, amicus curiae.

SHEPARD, Chief Justice.

The question is whether the parents of a patient in a persistent vegetative state may authorize the withdrawal of artificially provided nutrition and hydration from their never-competent daughter. We hold that they may.

Case History

When this litigation began, Sue Ann Lawrance was a forty-two year old woman who was "completely nonverbal, nonambulatory, requir[ing] total care and ... only sustained by artificially delivered nutrition and hydration." Amended Order on Petition for Authority at 3. She died during the course of this appeal. Sue Ann had been healthy until the age of nine, when she displayed symptoms of intracranial pressure and underwent a craniotomy. She suffered permanent brain damage and attended special schools and camps for the mentally handicapped. From at least 1966 to 1979, Sue Ann suffered balancing problems and seizures which became more frequent over time. In 1987, she fell while attending camp and underwent a second craniotomy. On July 24, 1987, she was admitted to the Manor House nursing home in Noblesville. She remained in a persistent vegetative state from approximately that time until her death.

On March 4, 1991, Sue Ann Lawrance's parents petitioned the Hamilton Superior Court for authority to withdraw their daughter's artificially provided nutrition and hydration. In their amended petition, the parents asked that the court make ten findings, which we condense as follows: (1) that Sue Ann Lawrance has been in a persistent vegetative state since June 1987, that she is never expected to recover, and that continued treatment is futile; (2) that Sue Ann cannot make her own health care decisions and that she has no appointed health care representative; (3) that the Indiana Health Care Consent Act (HCCA) includes in its definition of "health care" the administration of artificially provided nutrition and hydration; (4) that Sue Ann's mother and father have the authority to withdraw consent for unwanted health care under Indiana Code Sec. 16-8-12-4; (5) that the parents can order the withdrawal of artificially delivered nutrition and hydration for their daughter under an objective "best interests" standard; (6) that the United States and Indiana constitutions guarantee Sue Ann the right to refuse unwanted treatment, including nutrition and hydration; and that Sue Ann's parents can make this refusal on her behalf. March 15 Amended Petition.

The trial court held a hearing on March 26, 1991. The testimony demonstrated that Sue Ann's parents and four siblings all agreed with the decision to withdraw artificial nutrition and hydration. Sue Ann's treating physician, Dr. Thomas Miller, testified at the hearing, and the court received into evidence a letter from Sue Ann's neurologist Dr. Wesley Wong. Both doctors confirmed that the patient was in a persistent vegetative state, that recovery was not expected, and that the doctors supported the family's decision. ¹

Manor House, though not a party, participated at the hearing. Counsel for the nursing home cross-examined each of the family's witnesses and also presented her own witnesses. Diane Huestis, the home's administrator, testified that Manor House was taking no position on the parents' petition, and that the home would comply with the decision of the court. Throughout the proceeding, however, Manor House made clear its concern that the home remained subject to state and federal regulation and sanction regardless of the decision of Sue Ann's family and doctors.

Judge Jerry Barr entered his order on May 2, 1991, and made minor amendments on May 8 and May 16, 1991. He held in relevant part: (1) that Sue Ann was in a persistent vegetative state; (2) that Sue Ann's parents had authority under the HCCA "to consent, as surrogate decisionmakers, to the withdrawal of artificially delivered nutrition and hydration from their daughter ... who would otherwise remain indefinitely in a persistent vegetative state"; (3) that "the liberty interest of the individual, as set forth in Article I, Sec. 1 of the Indiana Constitution, does include the right of Sue Ann Lawrance to be free from unwanted medical treatment and that said Article further requires the State to give effect to the decision of Sue Ann's surrogate decision makers"; (4) that the Indiana State Board of Health has no further jurisdiction regarding Sue Ann's nutrition and hydration, and that they should not interfere with the decisions of Sue Ann's surrogate decisionmakers and doctors; (5) that Manor House "or any successor nursing home facility, any hospital, or any health care provider" should not interfere with the treatment plans of the surrogate decisionmakers, and that they should permit withdrawal of "all or part of any artificial nutrition and hydration of Sue Ann Lawrance as her physicians and surrogate decision makers shall direct."

Some time after May 2, 1991, the family moved Sue Ann from the nursing home in Hamilton County to St. Vincent's Hospice in Marion County. A group called The Christian Fellowship with the Disabled then petitioned for her guardianship in the probate division of the Marion Superior Court. On May 16, 1991, Judge Charles J. Deiter held a hearing at which the Fellowship, Sue Ann's parents, Manor House, St. Vincent's, and others were present. Judge Deiter appointed a guardian ad litem to represent Sue Ann for purposes of that hearing. The court granted the Fellowship's petition and appointed its attorney Patti Mullins as Sue Ann's temporary limited guardian. Mullins' authority was limited to seeking a stay or other relief from the judgment of the Hamilton Superior Court and seeking appellate review of the judgment of the Hamilton Superior Court.

On May 17, 1991, Mullins requested a stay of the Hamilton County order from Judge Barr. At a hearing on May 18, 1991, the parents agreed to stay withdrawal of nutrition and hydration for twenty-one days. In light of this agreement, the court stayed its order for twenty-one days.

On May 23, 1991, Mullins resigned as temporary limited guardian. Judge Deiter appointed Daniel Avila as successor temporary limited guardian. Avila is an attorney with the National Legal Center for the Medically Disabled and Dependent. On May 30, Avila moved to be joined as an additional party in the Hamilton case. Judge Barr denied the motion the same day. On June 3, Avila moved Judge Barr to stay his order pending appeal; Judge Barr denied this motion on June 5.

Avila as appellant next filed a motion in the Court of Appeals on June 6 asking for a stay pending appeal. The Court of Appeals heard argument concerning that request on June 7 and granted a stay providing a record of the proceedings was filed by June 14, 1991, at 4:30 p.m. The record was timely filed on June 14. This Court then granted the parent-appellees' "Verified Petition for Transfer to the Supreme Court," which they had filed on June 5.

Both sides raise a number of issues on appeal. These issues generally touch on three questions: whether the temporary limited guardian has standing to bring this appeal; whether Judge Barr erred in denying Avila's motion to be joined as a party and whether Judge Barr erred in holding that the Health Care Consent Act authorized the Lawrances as surrogate decisionmakers to withdraw Sue Ann's nutrition and hydration.

On July 18, 1991, Sue Ann Lawrance died of natural causes. Both sides to this litigation have expressed their desire to proceed with the case despite her death.

The Question of Mootness

The long-standing rule in Indiana courts has been that a case is deemed moot when no effective relief can be rendered to the parties before the court. When the concrete...