Woods Ex Rel. Simpson v. Commonwealth

Summary

The Supreme Court of Kentucky considered whether KRS 311.631 constitutionally permits a court-appointed guardian or surrogate to authorize withdrawal of artificial life-prolonging treatment from a permanently unconscious or persistently vegetative patient. The court affirmed the lower courts' holdings that the statute permits such decisions without prior judicial approval absent a dispute, but held that withdrawal requires clear and convincing evidence that the patient is permanently unconscious or in a persistent vegetative state and that withdrawal is in the patient's best interest. The case also addresses substituted judgment, best-interest standards, and the mootness exception for disputes capable of repetition yet evading review.

Holdings

1. KRS 311.631 authorizes a surrogate listed in the statutory order of priority, including a judicially appointed guardian, to make health-care decisions for an adult patient lacking decisional capacity and without an applicable advance directive, including withholding or withdrawing life-prolonging treatment when the statutory conditions are met.
2. KRS 311.631 is not unconstitutional on its face because it provides a mechanism for balancing the patient's liberty interest in refusing unwanted medical treatment against the Commonwealth's interests in preserving life and protecting other interests.
3. When the patient's wishes are unknown or unreliable, KRS 311.631 permits the surrogate and, if necessary, the court to determine whether withdrawal is in the patient's best interest using both subjective evidence about the patient's values and objective evidence concerning the patient's condition, prognosis, treatment burdens, and benefits.
4. A guardian need not obtain prior judicial approval or appointment of a guardian ad litem to authorize withdrawal of life-prolonging treatment when the guardian, treating physicians, family, and ethics committee, if any, agree. Judicial intervention is appropriate when interested parties disagree.
5. When a dispute requires court intervention, withdrawal or withholding of life-prolonging treatment is prohibited unless clear and convincing evidence establishes that the patient is permanently unconscious, in a persistent vegetative state, or facing inevitable death within a few days, and that withdrawal is in the patient's best interest.

Questions Presented

1. Whether KRS 311.631 authorizes a judicially appointed guardian or other statutory surrogate to withhold or withdraw artificial life-prolonging treatment from an adult patient lacking decisional capacity who has not executed an advance directive.
2. Whether KRS 311.631 is constitutional under the Kentucky and United States Constitutions.
3. Whether the statute permits withdrawal of life-prolonging treatment based on the patient's best interest, including objective quality-of-life considerations, rather than only substituted judgment based on known patient wishes.
4. Whether a guardian must obtain prior judicial approval or appointment of a guardian ad litem before authorizing withdrawal of life support.
5. Whether clear and convincing evidence is required to establish that the patient is permanently unconscious or in a persistent vegetative state and that withdrawal of life support is in the patient's best interest.
6. Whether the statute violates public policy or modern legal, medical, or moral ethical standards.

Disposition

other