Martin, In re
| Decision Date | 19 July 1993 |
| Docket Number | 161431,Docket Nos. 161299 |
| Citation | 504 N.W.2d 917,200 Mich.App. 703 |
| Parties | In re Michael MARTIN, a legally incapacitated person. Mary MARTIN, guardian and conservator of Michael Martin, a legally incapacitated person, Petitioner-Counter Respondent-Appellant, v. Leeta M. MARTIN and Patricia Major, Respondents-Counter Petitioners-Appellees. Mary MARTIN, guardian and conservator of Michael Martin, a legally incapacitated person, Petitioner-Counter Respondent-Appellee, v. Leeta M. MARTIN and Patricia Major, Respondents-Counter Petitioners-Appellants. |
| Court | Court of Appeal of Michigan — District of US |
Vlcko, Lane, Payne & Broder, P.C. by Andrew J. Broder and Lynn Stevens Naoum, Bingham Farms, for Mary Martin.
Hess & Hess, P.C. by John H. Hess and Daniel B. Hess, Grand Rapids, for Leeta M. Martin and Patricia Major.
Kerr, Russell & Weber by Richard D. Weber and Joanne Geha Swanson, Detroit, for amicus curiae MI State Medical Soc.
Van Dam & Jesson, P.C. by Theresa K. Phelps, Grand Rapids, and Nat. Legal Center for the Medically Dependent and Disabled, Inc. by James Bopp, Jr., Thomas J. Marzen, Daniel Avila, and John Altomare, Indianapolis, IN, for amicus curiae Ethics and Advocacy Task Force of Nursing Home Action Group.
Before WAHLS, P.J., and SHEPHERD and Mark J. CAVANAGH, JJ.
In these consolidated appeals, petitioner Mary Martin and respondents Leeta Martin and Patricia Major appeal as of right from a November 12, 1992, order of the Allegan County Probate Court, which, following a hearing, denied Mary Martin's petition as guardian of Michael Martin (her spouse) for authority to withdraw all artificial means of life support from Michael, including nutritive support, and also denied respondents' petition to have Mary Martin removed as guardian of and conservator for Michael. Respondents also appeal a February 3, 1993, injunction prohibiting them from interfering in the medical treatment of Michael and a separate order denying their request for attorney fees. We remand for further proceedings consistent with this opinion.
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.
This Court recently held in In re Rosebush, 195 Mich.App. 675, 681-682, 491 N.W.2d 633 (1992), that a competent adult patient has the right to refuse life-sustaining medical treatment as an aspect of the common-law doctrine of informed consent and that such right is not lost because of the subsequent incompetence of the patient. 1 The Court stated that where a patient lacks the capacity to make a decision concerning medical treatment, a surrogate decision-maker may exercise the right to refuse treatment by applying either a "substituted judgment" or a "best interests" standard, whichever is appropriate. Id. at 688-690, 491 N.W.2d 633. We agree with these principles but expand upon them further.
Because a patient's right of self-determination is generally recognized as outweighing any countervailing state interests, where a patient currently has the requisite decision-making capacity, the expressed statements of the patient regarding medical treatment will generally control that patient's care, regardless of the consequences of the decision. Rosebush, supra at 681, n. 2, 688, 491 N.W.2d 633. Cf. Cruzan v. Director, Missouri Health Dep't, 497 U.S. 261, 279, 110 S.Ct. 2841, 2852, 111 L.Ed.2d 224 (1990).
Likewise, where a patient has lost the requisite decision-making capacity, it is still the goal to effectuate the patient's right of self-determination. In re Conroy, 98 N.J. 321, 380-381, ...
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