Martin, In re

• Decision Date: 22 August 1995
• Docket Number: Nos. 99699,99700,No. 10,s. 99699,10
• Citation: 538 N.W.2d 399,450 Mich. 204
• Parties: , 64 USLW 2156, 7 NDLR P 165 In re Michael MARTIN, a Legally Incapacitated Person. Mary MARTIN, Guardian and Conservator of Michael Martin, Petitioner-Counter Respondent-Appellee, v. Leeta M. MARTIN and Patricia Major, Respondents-Counter Petitioners-Appellants. Calendar
• Court: Michigan Supreme Court

Page 399

538 N.W.2d 399

450 Mich. 204, 64 USLW 2156, 7 NDLR P 165

In re Michael MARTIN, a Legally Incapacitated Person Mary MARTIN, Guardian and Conservator of Michael Martin Petitioner-Counter Respondent-Appellee, v. Leeta M. MARTIN and Patricia Major, Respondents-Counter Petitioners-Appellants.

Nos. 99699, 99700.

Calendar No. 10.

Supreme Court of Michigan.

Argued March 7, 1995.

Decided Aug. 22, 1995.

Irving M. Stahl, guardian ad litem, Southfield, for Michael Martin.

Vlcko, Lane, Payne & Broder, P.C. by Andrew J. Broder, Lynn Stevens Naoum, and Thomas F. Naughton, Bingham Farms, for Mary Martin.

Hess & Hess, P.C. by John H. Hess and Daniel B. Hess, Grand Rapids, for Patricia Major and Leeta Martin.

Ann E. Fade, and Anna Moretti Kavolius, New York City, Foster, Swift, Collins & Smith, of counsel by Brian A. Kaser, Lansing, for amicus curiae Choice In Dying.

Honigman, Miller, Schwartz & Cohn by Michael A. Gruskin and Lee W. Brooks, Detroit, for amicus curiae Michigan Health and Hospital Association.

Stewart R. Hakola, Marquette, Calvin A. Luker, Livonia, and Lisa K. Gigliotti, Lansing, for Michigan Protection and Advocacy Service, Inc., American Disabled for Assistant Programs Today, the Association for Community Advocacy, the ARC Michigan, the Autism Society of Michigan, the Disability Network, the Disability Rights Bar Association, and United Cerebral Palsy of Michigan.

James W. Kraayeveld, Grand Rapids, James Bopp, Jr., Thomas J. Marzen, Daniel Avila, John Altomare, and Jane E.T. Brockmann, Indianapolis, IN, for Michigan Handicapper Caucus, and the Ethics and Advocacy Task Force of the Nursing Home Action Group.

Kerr, Russell & Weber by Richard D. Weber and Joanne Geha Swanson, Detroit, for Michigan State Medical Society.

Opinion

MALLETT, Justice.

We granted leave in this case to consider whether life-sustaining treatment in the form of a gastrostomy tube that provides nutritive support should be removed from a conscious patient who is not terminally ill or in a persistent vegetative state, but who suffers from a mixture of cognitive function and communication impairments that make it impossible to evaluate the extent of his cognitive deficits. ¹

The trial court determined that there was clear and convincing evidence that, before his injuries, Michael Martin "expressed [a medical] preference to decline life-sustaining medical treatment under the circumstances presented...." ² The Court of Appeals affirmed the trial court's determination. ³

After painstaking review of the facts of this case, we reverse the Court of Appeals decision because we conclude that there is not clear and convincing proof that Michael made a firm and deliberative decision, while competent, to decline medical treatment in these circumstances.

As we begin our analysis, we are mindful that the paramount goal of our decision is to honor, respect, and fulfill the decisions of the patient, regardless of whether the patient is currently competent. The decision to accept or reject life-sustaining treatment has no equal. We enter this arena humbly acknowledging that neither law, medicine nor philosophy can provide a wholly satisfactory answer to this question.

To err either way has incalculable ramifications. To end the life of a patient who still derives meaning and enjoyment from life or to condemn persons to lives from which they cry out for release is nothing short of barbaric. If we are to err, however, we must err in preserving life.

I

A

The Court of Appeals opinion presents an accurate and thorough summary of the facts:

Petitioner and Michael Martin were married in 1972 and thereafter had three children. On January 16, 1987, Michael sustained debilitating injuries in an automobile accident, with the most serious being a closed head injury affecting the bilateral hemisphere of his brain. The injuries significantly impaired his physical and cognitive abilities, left him unable to walk or talk, and rendered him dependent on a colostomy for defecation and a gastrostomy tube for nutrition. Petitioner was appointed Michael's legal guardian and conservator. Michael resided at different nursing homes for the first few years after the accident until July 1990, when he was transferred to the New Medico Neurological Center (NMNC) in Howell, Michigan, where he was still residing at the time of the hearing.

On January 9, 1992, while Michael was being treated at Butterworth Hospital for an obstructed bowel, petitioner contacted the hospital's bioethics committee for the purpose of determining whether Michael's life-sustaining medical treatment should be withdrawn. On January 15, 1992, after consulting with petitioner, a family friend, a social worker, Michael's treating physician, and nurses at Butterworth Hospital, the committee issued a report stating that withdrawal of Michael's nutritive support was both medically and ethically appropriate, but that court authorization would be required before the hospital would assist in the procedure. None of the personnel at the NMNC and no other members of Michael's family were consulted or notified by the committee.

On March 19, 1992, petitioner filed a petition in the probate court, requesting authorization to withdraw Michael's nutritive support. Respondents Leeta Martin and Patricia Major, who are Michael's mother and sister respectively, opposed the petition and also filed a petition of their own asking that Mary Martin be removed as Michael's guardian and conservator. An evidentiary hearing was held from October 13, 1992, through October 30, 1992, regarding the petition for authority to withdraw Michael's nutritive support.

Petitioner said that Michael was a private but active person before the accident. She claimed that he was always bothered by, and intolerant of, people who were disabled or dependent on others and often stated that he would rather die than be dependent on people and machines. According to petitioner, Michael would not want to be kept alive in his present condition. Two co-workers of Michael each testified that he had remarked to them before the accident that he would not want to continue living in a vegetative state. The remark was made to one of the co-workers during a casual conversation around the lunch table and to the other while discussing someone else who had been severely injured. Both co-workers testified that Michael's present condition is not the type Michael was referring to in the conversations before his accident. Respondent Patricia Major admitted that Michael once told her that he would not want to be kept alive by a respirator if he were in a coma.

Conflicting testimony was presented regarding Michael's current level of physical, sensory, emotional, and cognitive functioning. At one extreme, Dr. Joseph Fischhoff, who is head of the Department of Psychiatry at Wayne State University and the chairman of the bioethics committee at Children's Hospital in Detroit, testified that Michael has no voluntary control over any of his limbs, or any ability to function on a voluntary level, and therefore lacks any meaningful interaction with his environment. However, Dr. Robert Kreitsch, who is the director of the Brain Injury Rehabilitation Program at the Mary Free Bed Rehabilitation Center, testified that Michael demonstrated an ability to carry out some voluntary motor commands on his right side, including the ability to pinch and grasp, as well as the ability to recognize faces, respond emotionally, and communicate with others with head nods. According to Dr. Kreitsch, Michael seemed content with his environment and indicated "no" with a head nod when asked whether he has been in any pain or discomfort, and also when asked if there were ever any times when he felt that he did not want to go on living. Other medical experts also presented differing opinions regarding Michael's level of functioning, but generally described it as falling somewhere between that described by Drs. Fischhoff and Kreitsch. All medical experts agreed that Michael was not in a persistent vegetative state or terminally ill.

Petitioner, several therapists from the NMNC, and several lay witnesses all described an apparent limited ability by Michael to interact with others and to respond to simple yes or no questions with head nods; their testimony varied, however, with respect to the consistency and appropriateness of the perceived interaction and responses. The trial judge personally visited and questioned Michael at the NMNC on October 14, 1992. The judge explained on the record how Michael had moved both his right arm and right leg on command, and how he had responded with appropriate head nods to a series of yes or no questions. Witnesses also testified that there are times when Michael becomes completely withdrawn and does not respond to any stimuli.

In a decision delivered from the bench on October 30, 1992, the trial court ruled that clear and convincing evidence had been presented that Michael did not want to be "kept a dependent person" and that his present condition "falls within what Michael did not want to be." Nonetheless, the court held that Michael's intentions could not be considered because they were not expressed in writing. The trial court further ruled that withdrawal of nutritive support was in Michael's best interests, but that, absent being terminally ill, a best interests standard could not be applied as a matter of law. Accordingly, the trial court denied the petition for authority to withdraw Michael's nutritive support. The trial court then proceeded to also deny respondents' petition for removal of Mary Martin as Michael's guardian and conservator. The court concluded that her "decision-making process" relative to the decision to withdraw life-sustaining medical treatment was not inappropriate. Motions for reconsideration brought by both sides, including a request by respondents for specific factual findings, were thereafter denied. [200...