S.I. v. R.S.
24 Misc. 3d 567, 877 N.Y.S.2d 860 (2009)
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Rule of Law:
A health care agent's decision to withdraw life-sustaining treatment is valid if it is based on the patient's reasonably known wishes, which can be established through consistent, specific verbal statements that clarify an otherwise general or ambiguous written instruction in a health care proxy.
Facts:
- The patient, S.S., suffered from obesity and related breathing problems.
- In November 2006, S.S. was hospitalized and required a tracheotomy, a temporary ventilator, and a feeding tube.
- Following this experience, S.S. repeatedly and emphatically told his wife, R.S., and his pulmonologist, Dr. A., that he did not want to live dependent on machines and tubes, considering it 'no way to live.'
- On January 5, 2009, during a doctor's visit, S.S. was advised that his future might depend on a respirator.
- At that same visit, S.S. executed a health care proxy appointing his wife, R.S., as his agent.
- At S.S.'s direction, R.S. wrote 'I wish to live' in the optional instructions section of the proxy form.
- S.S. was raised in an Orthodox Jewish household but was not an observant adult, unlike his siblings, F.H. and S.I., who held strong religious beliefs about prolonging life.
- Shortly after executing the proxy, S.S. suffered a heart attack and severe neurological damage, leaving him incapacitated and dependent on a ventilator.
Procedural Posture:
- S.S.'s sister, F.H., filed a petition in the Supreme Court of Nassau County, a trial-level court in New York, seeking to be appointed as S.S.'s guardian.
- The petition also sought to void the health care proxy appointing S.S.'s wife, R.S., as his agent and to compel the continuation of life-sustaining treatment.
- The court issued a temporary restraining order preventing the hospital from disconnecting the ventilator pending a hearing.
- At the start of the hearing, the court granted a motion to add S.S.'s brother, S.I., as a co-petitioner.
- The court then conducted an evidentiary hearing at the hospital where S.S. was being treated.
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Issue:
Does a health care agent act in accordance with a patient's wishes, as required by New York Public Health Law, when she directs the withdrawal of life-sustaining treatment based on the patient's repeated verbal statements that he did not want to live on machines, despite a written instruction in the health care proxy stating, 'I wish to live'?
Opinions:
Majority - Murphy, J.
Yes, a health care agent acts in accordance with the patient's wishes when the decision is based on specific, repeated verbal instructions regarding treatment that serve to clarify a general written statement in the health care proxy. The court found overwhelming evidence from the testimony of both the agent (R.S.) and the treating physician (Dr. A.) that S.S. consistently and emphatically stated he did not want to live on a respirator or be kept alive by machines. The court reconciled the seemingly contradictory statements by interpreting the written phrase 'I wish to live' in the context of S.S.'s verbal declarations. It concluded that S.S. meant he wished to live 'on his terms,' enjoying an active life, not merely exist in a vegetative state sustained by machines. The court gave little weight to the religious arguments of the petitioners (S.S.'s siblings), as the evidence showed S.S. did not share their observant beliefs. Therefore, the petitioners failed to meet their burden to prove the agent was acting in bad faith or contrary to the patient's reasonably known wishes.
Analysis:
This decision reinforces the significant authority granted to a health care agent and clarifies the judicial standard for interpreting a patient's wishes. It establishes that courts may look to extrinsic evidence, such as consistent verbal statements to family and physicians, to interpret and give meaning to general or ambiguous written instructions in a health care proxy. The case prioritizes a holistic understanding of a patient's values and specific desires over a literal, decontextualized reading of a single phrase. This precedent provides strong support for agents whose decisions are challenged by other family members, so long as the agent's actions are grounded in a well-established understanding of the patient's true intent.
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