## Facts

- Rueben Betancourt, age 73, underwent surgery at Trinitas Hospital to remove a malignant thymus tumor.
- In the post-operative ICU, his ventilation tube became dislodged, causing hypoxia and anoxic encephalopathy that left him in a persistent vegetative state.
- He required extensive life-sustaining measures, including ventilator support, thrice-weekly dialysis, tube feeding, and treatment for severe pressure ulcers complicated by osteomyelitis.
- Treating physicians agreed his brain injury was irreversible but disagreed about whether he could experience pain (one describing reactions as pain responses; another describing them as reflexes).
- Betancourt had no advance directive, no designated health-care representative, and no expressed wishes regarding withholding or withdrawal of life-sustaining treatment.
- Trinitas physicians and an ethics committee concluded continued aggressive treatment was medically inappropriate and, after failed discussions with the family, placed a DNR order in his chart over the family’s objection.
- Jacqueline Betancourt (his daughter) contested the futility determination, asserted he showed responsiveness, sought guardianship, and sued to prevent limitation or withdrawal of treatment.
- The Chancery Division enjoined Trinitas from withdrawing life-sustaining treatment, ordered the prior level of treatment restored, and appointed Jacqueline Betancourt as guardian/surrogate.
- Trinitas appealed; during the appeal, Rueben Betancourt died.

## Issues

1. Whether the patient’s death rendered moot the hospital’s appeal from an injunction requiring continued life-sustaining treatment and related orders.
2. Whether the court should decide, despite mootness, the broader dispute over “medical futility” and unilateral DNR/withdrawal decisions under a public-interest exception to mootness.

## Decision

- The Appellate Division dismissed the appeal as moot because the patient’s death ended any live controversy over continued treatment and made effective injunctive relief impossible.
- The court declined to apply a mootness exception to decide the underlying medical-futility questions.
- The court refused to announce a rule on whether, or under what circumstances, a hospital in New Jersey may unilaterally withhold or withdraw life-sustaining treatment deemed futile over family objection.
- The court indicated that broad end-of-life policy disputes involving medical futility and resource allocation are better addressed through legislative action and statewide policy development than through case-by-case adjudication in a moot appeal.

## Legal Principles

- An appeal challenging an injunction governing life-sustaining treatment becomes moot upon the patient’s death because the court can no longer grant meaningful relief affecting the patient’s care.
- Courts generally will not decide abstract ethical or legal questions once a case is moot, absent a recognized exception.
- Even where disputed end-of-life issues are of public importance and likely to recur, an appellate court may decline to reach the merits where the dispute is policy-laden and better suited to legislative resolution.
- Dismissal on mootness grounds does not constitute approval of either party’s substantive position regarding the permissibility of continued treatment or unilateral futility determinations.

## Conclusion

The Appellate Division dismissed as moot a hospital’s appeal from orders requiring continued life-sustaining treatment after the patient died, and it declined to use the case to set statewide rules governing unilateral medical-futility decisions, leaving such policy choices to the Legislature.


Betancourt v. Trinitas Hosp., 1 A.3d 823 (N.J. Super. Ct. App. Div. 2010)