In the Matter of Westchester County Medical Center, on Behalf of
Mary O'Connor, Appellant.
Helen A. Hall et al., Respondents
Court of Appeals of New York
72 N.Y.2d 517; 534 N.Y.S.2d 886; 531 N.E.2d 607.
Decided October 14, 1988, As Amended April 11, 1989.
Facts:
Prepared by Tony Szczygiel
Mary O'Connor, a hospital patient, lacked the mental
capacity to decide on her own course of medical treatment. Two
major strokes had caused irreparable damage to her brain. After
the strokes, Ms. O'Connor lost her gag reflex, so she could not
drink or eat without medical assistance. Her prognosis was not
clear, nor was it known whether she would recover her gag reflex.
Her treating physician in the hospital determined that Ms. O'Connor
needed a nasogastric tube to provide more substantial, and long
term, nourishment than was possible with intravenous fluids and
nourishment. The physician had not known Ms. O'Connor prior to her
loss of capacity, and did not know her wishes as to life-sustaining
care. Ms. O'Connor's daughters objected to the proposed
intervention based on their mother's prior statements that she
wanted no artificial life support to be started or maintained in
order to continue or sustain her life. The hospital ethics
committee rendered an opinion that it would be inappropriate not to
insert the NG tube, under the circumstances.
Case History:
Westchester County Medical Center applied to the New
York State Supreme Court for approval of the hospital's insertion
of a nasogastric feeding tube in Mary O'Connor. Ms. O'Connor's
daughters raised a counterclaim to discontinue the intravenous
feeding of Mary O'Connor. The Supreme Court denied the request of
the hospital, and granted that of the daughters.
The hospital appealed to the next level in New York's court
system, the Appellate Division. The hospital was granted a stay of
the lower court's order, allowing them to continue the NG tube
pending the appeal. The Appellate Division panel of judges
affirmed the Supreme Court order, by a 3 to 2 vote. The majority
decision and the two dissents are reported at Matter of Westchester
County Med. Center (O'Connor), 139 AD2d 344, 532 N.Y.S.2d 133
(August 16, 1988).
The hospital appealed the Appellate Division ruling to the
highest state court, the New York Court of Appeals. The Court of
Appeasl reversed the lower courts, and granted the hospital
permission to insert the NG tube.
Primary Holdings:
- Absent legislative authorization, there can be no surrogate
decisionmaking to decline life-sustaining care in New York.
- To establish the choice that would have been made by a now-
incapacitated adult, there must be clear and convincing proof that
the patient, while competent, had made a firm and settled
commitment to decline the specific medical assistance in the
circumstances that later arose.
Chief Judge Wachtler wrote the
majority opinion, joined by Judges
Kaye, Titone and Bellacosa. Judge Hancock, Jr. agreed with the
result but wrote a
separate opinion. Judge Simons wrote the
dissenting opinion, joined by Judge Alexander.
Continue on to Opinion.
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