Conroy, Claire

Claire Conroy was an 84 year-old resident of a nursing home. She suffered severe dementia and had a nasogastric feeding tube because she could not take adequate nourishment orally. She was bedridden, unable to speak, incontinent and contracted into a semi-fetal position, with several decubiti and a gangrenous left leg. Although not in a persistent vegetative state, she interacted with her environment in limited ways. Her only relative was a nephew, who visited her regularly. He went to court as her legal guardian in January of 1983 to request that the feeding tube be removed because he believed she would not want it. The trial court permitted the tube to be withdrawn but the decision was stayed pending appeal. Ms. Conroy died while the case was under appeal. Despite her death, the appeals process continued because of the importance of the issues raised by the case. An appellate court reversed the trial court decision. The New Jersey Supreme Court ruled that tube feedings, like other life-sustaining treatments, may be withheld if they are against the patient’s wishes or best interests.

The court believed that incompetent patients in nursing homes needed more procedural safeguards. It rejected the traditional practice of joint decisions by physicians and families of incompetent patients. Instead, the court mandated the following procedure: 1) the patient must be judged incompetent to make treatment decisions, and a guardian must be appointed by the courts; 2) the state office of ombudsman must be notified of any intention to withdraw life-sustaining treatment, and the case must be treated as a possible case of "abuse;" and 3) the guardian, attending physician and ombudsman may agree to withhold or withdraw life-sustaining treatment if the subjective test, pure-objective test or limited objective test is satisfied. [Source: In Re Conroy, 486 A. 2d. 1209 (1985).] The ruling, like other State Supreme Court rulings, sets no precedence for other states, but has influenced the thinking of other State Supreme Courts.

Principles & Concepts: human dignity, informed consent, substituted judgment, best interests, beneficence, benefits and burdens, proportionate/ disproportionate means.

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