Life-sustaining treatment may be withheld or withdrawn from an incompetent patient when there is evidence the patient would have refused it and a guardian is satisfied that the burdens of living outweigh the benefits, the New Jersey Supreme Court ruled Thursday.
The state's highest court called the concept the "limited-objective" test and also established a "pure-objective" test, under which the burdens of a patient's life with treatment should clearly and markedly outweigh the benefits a patient derives from life.
Treatment can be withdrawn if the conditions of either test are met, the court said in its 6-1 decision.
The justices limited their ruling to cases like that of Claire C. Conroy, 84, a nursing home patient who died Feb. 15, 1983, during a legal battle over whether a tube supplying food and medicine through her nose could be removed.
The issue in the case was whether a feeding tube is the same as a respirator and therefore could be removed under the court's right-to-die decision in the Karen Ann Quinlan case.
"A competent patient has the right to decline any medical treatment, including artificial feeding, and should retain that right when and if he becomes incompetent," said now-retired Associate Justice Sidney M. Schreiber, who wrote the 82-page majority opinion.
"In addition, in the case of an incompetent patient who has given little or no trustworthy indication of an intent to decline treatment and for whom it becomes necessary to engage in balancing under the limited-objective or pure-objective test, the pain and invasiveness of an artificial feeding device, and the pain of withdrawing that device, should be treated just like the results of administering or withholding any other medical treatment," Schreiber said.
"Further, the recurring, unavoidable and severe pain of the patient's life with the treatment should be such that the effect of administering life-sustaining treatment would be inhumane," he said.
The court had ruled in a landmark 1975 decision that Miss Quinlan's parents had the constitutional privacy right to order the removal of a respirator from the comatose woman. The respirator was disconnected and she remains in a coma.