## Facts

- Robert Wendland suffered severe traumatic brain injury in a 1993 single-vehicle accident and remained comatose for about 16 months before regaining consciousness with profound cognitive and physical disabilities.
- Robert was conscious and intermittently responsive to simple commands with coaching, but could not reliably communicate, swallow, or manage basic bodily functions.
- Robert received artificial nutrition and hydration (ANH) through a feeding tube and was not terminally ill, comatose, or in a persistent vegetative state (PVS).
- Robert left no written advance directive and did not appoint a health-care agent or surrogate.
- Rose Wendland, Robert’s wife, sought to withdraw ANH, relying in part on Robert’s alleged pre-injury statements that he would not want to live as a “vegetable,” in a coma, or unable to perform basic activities such as feeding himself or communicating.
- Robert’s mother and other family members opposed withdrawal of ANH and obtained temporary court orders to prevent removal of the feeding tube.

## Issues

1. Whether a conservator may withhold or withdraw ANH from a conscious conservatee who is not terminally ill, comatose, or in PVS, and who left no formal health-care instructions or appointed agent.
2. If such authority exists, what standard of proof applies to show that withdrawal accords with the conservatee’s wishes or best interests.
3. Whether general conservatorship powers or California’s health-care decision statutes authorize withdrawal of ANH in these circumstances.

## Decision

- The California Supreme Court reversed the Court of Appeal and affirmed the trial court’s denial of authority to withdraw ANH.
- The court held that a conservator may not withdraw ANH from a conscious conservatee in these circumstances unless there is clear and convincing evidence that the decision reflects the conservatee’s own wishes or is in the conservatee’s best interests.
- The court concluded the evidence offered—primarily informal, generalized pre-injury statements—did not meet the clear and convincing standard as applied to Robert’s actual condition.

## Legal Principles

- A competent adult has constitutional and common-law rights to refuse medical treatment, including life-sustaining treatment such as ANH.
- When a patient is incompetent but conscious and has left no formal instructions or appointed agent, heightened safeguards are required before authorizing withdrawal of ANH.
- Withdrawal of ANH from a conscious conservatee requires clear and convincing evidence that withdrawal matches the conservatee’s wishes (substituted judgment) or is in the conservatee’s best interests.
- A conservator’s good-faith preference is not an evidentiary standard and does not, standing alone, justify withdrawing ANH.
- Courts must distinguish conscious, severely disabled patients from PVS patients; the state’s interests in preserving life and protecting vulnerable persons carry greater weight when the conservatee is conscious and responsive to some degree.
- Informal, general pre-injury remarks about not wanting to live in a severely impaired state may be insufficient to constitute clear and convincing evidence regarding a specific later medical condition.
- Best-interests determinations must not rest solely on value judgments about disability or generalized “quality of life” assessments.

## Conclusion

The court required clear and convincing evidence of a conscious conservatee’s wishes or best interests before a conservator may withdraw artificial nutrition and hydration where no formal directive or appointed agent exists, and it upheld denial of withdrawal because that standard was not met.


Conservatorship of Wendland, 26 Cal. 4th 519, 28 P.3d 151 (Cal. 2001)