Legal Caselist

This table summarizes some of the key legal decisions that address what courts have decided when a patient is either incompetent, unconscious, in a permanent vegetative state, or otherwise unable to speak for him or herself, and there is no advance directive to answer the question whether the patient wanted ANH in the particular circumstances noted.


Caselaw Pertaining to Artificial Nutrition and Hydration

Case Year Courts involved and case citations Applicable State Law(s) Pertinent Facts Legal Significance
In re Quinlan 1976 New Jersey Supreme Court 355 A.2d 647(NJ, 1976)   -Pt in PVS on ventilator-Pt being fed enterally Pt has a right to stop artificial life support (does not address ANH)
Cruzan v. Director, Missouri Dept. of Health 1990 United States Supreme Court 497 U.S. 261 (1990) Mo. Rev. Stat § 459.011 (1986) -Pt in PVS for 5 years -Pt being fed enterally-Family wanted to stop enteral nutrition-After USSC decision, to meet high evidentiary standard, family presented witnesses who testified to pt’s previously expressed desire NOT to have life sustained by artificial means.  -ANH is medical treatment-Competent individuals have a Constitutionally protected right to refuse life sustaining ANH-Individual states have the right to require “clear and convincing evidence” of a person’s desire to refuse ANH 
Gilmore v. Finn 2000 Virginia Supreme Court 527 S.E.2d 462 (Va. 2000) VA Code 54.1-2981 et seq. -Pt in PVS-Pt being fed enterally-Wife as guardian wanted to stop enteral feeding-Other family members and Governor of Virginia opposed wife -Withdrawal of ANH does not initiate the dying process but permits the already occurring natural process of dying
Wendland v. Wendland 2001 California Supreme Court 110 Cal. Rptr.2d 412 (Cal. 2001) Cal. Prob. Code § 2355 -Incompetent patient-NOT terminally ill, comatose, or PVS-No applicable advance directive -Court appointed conservator required-Conservator may NOT withhold ANH without clear and convincing evidencethat the decision is in the patient’s best interests
Woods v. Kentucky 2004 Supreme Court of Kentucky 142 S.W.3d 24 (Kentucky, 2004) K.R.S. § 311.631 -Pt ward of state-Low IQ; adjudicated incompetent prior to hospitalization-Cardiopulmonary arrest after asthma attack; was resuscitated-Doctors testified he was “permanently unconscious” but not in a PVS -Withdrawal of artificial life support prohibited absentclear and convincing evidencethat the patient is permanently unconscious or in a PVS and that withdrawal is in the patient’s best interests
Schiavo ex rel. Schindler v. Schiavo 2001 - 2005 U.S. Court of Appeals, Eleventh Circuit Florida’s Second District Court of Appeal Numerous opinions Fl Stat -Pt in PVS for x years-Husband asserted right to stop life support, including ANH-No advance directive-Pt’s parents opposed husband’s decision-Governor opposed cessation of life support-Case widely publicized in media -Federal appeals court refused to grant a temporary order that would have required hospital to re-start ANH 
Ussery v. Children’s Healthcare of Atlanta 2008 Court of Appeals of Georgia Ga law -34 month old child-anoxic encephalopathy after problematic intubation-parents consented in writing to cessation of nutrition support-later, parents claimed consent was invalid -Withdrawing nutrition support did NOT constitute an intentional tort under Georgia law