The Kentucky Supreme Court upholds a state statute allowing legal guardians to approve the withdrawal of life support from an adult patient who lacks decisional capacity and has not made an advance directive, so long as there is clear and convincing evidence that the patient is permanently unconscious or in a persistent vegetative state and that withdrawing life support is in the patient's best interest. Woods v. Commonwealth (Ky., No. 1999-SC-0773-DG, Aug. 26, 2004).
In 1991, a Kentucky court appointed an agent of the Cabinet for Human Resources to be the limited guardian of Matthew Woods, a mildly retarded 50-year-old man. The guardian had authority, among other things, to consent to medical procedures. In 1995, Mr. Woods suffered cardiopulmonary arrest during a severe asthma attack, resulting in total and irreversible cessation of brain function. All of the medical doctors involved in his case agreed that Mr. Woods's condition was irreversible and that artificial life-prolonging treatment should be withdrawn for humane reasons. The district court ruled that a provision of the Kentucky Living Will Directive Act authorizes a judicially-appointed guardian of an adult patient who lacks decisional capacity and has not made an "advance directive" to make health care decisions on behalf of the patient, including withdrawal of artificial life-support systems, without obtaining advance judicial approval, so long as the guardian acts in good faith and in the best interest of the patient.
A guardian ad litem appealed, arguing that the Act is unconstitutional or, if constitutional, the judicially-appointed guardian must prove by clear and convincing evidence that withdrawing artificial life support is in the patient's best interests; and that the statute violates public policy and modern ethical standards. (Woods died of natural causes before the circuit court could rule on the appeal.) The circuit court held that the Act is constitutional and does not require proof of the patient's best interest by clear and convincing evidence; that withdrawal of artificial life support systems from a permanently unconscious patient does not violate public policy or modern ethical standards if the decision is made in good faith and is in the ward's best interest; and that there is no need to obtain prior judicial approval of a decision to do so absent a dispute among interested parties as to the soundness of the decision. The Court of Appeals affirmed.
The Supreme Court of Kentucky affirms the holdings of the lower courts except as to the standard of proof. In that respect, it holds that the withdrawal of artificial life support from a patient is prohibited absent clear and convincing evidence that the patient is permanently unconscious or in a persistent vegetative state and that withdrawing life support is in the patient's best interest.
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