## Facts

- Claire C. Conroy, an 84-year-old nursing-home resident, was severely physically and mentally impaired, bedridden, and had a limited life expectancy.
- Her diagnoses included organic brain syndrome, hypertension, heart disease, diabetes, necrotic decubitus ulcers, and a gangrenous leg; she could not speak or swallow and had minimal interaction with her environment.
- Conroy received nutrition through a nasogastric (NG) feeding tube that functioned as her primary means of sustenance.
- Her court-appointed guardian (a nephew) sought judicial authorization to remove the NG tube; the guardian ad litem opposed withdrawal.
- The trial court authorized discontinuation of artificial feeding; the appellate court reversed and imposed narrow conditions for withholding nourishment (e.g., brain death, permanent vegetative state, or imminent death).
- Conroy died while the appeal was pending with the NG tube still in place; the court decided the case due to public importance and likelihood of recurrence.

## Issues

1. Under what circumstances may life-sustaining treatment, including artificial nutrition and hydration, be withheld or withdrawn from an incompetent, institutionalized elderly patient with severe, irreversible impairments and limited life expectancy?
2. What standards should govern surrogate and judicial decision-making when the patient’s treatment preferences are known, partially known, or unknown?
3. Whether artificially administered nutrition and hydration should be treated as medical treatment subject to refusal or as non-withdrawable basic care.

## Decision

- The Supreme Court of New Jersey reversed the Appellate Division’s restrictive rule and held that life-sustaining treatment, including artificial nutrition and hydration, may be withheld or withdrawn from an incompetent patient under defined standards.
- The court held that artificially administered nutrition and hydration (including NG tube feeding) are medical treatment and may be refused like other interventions.
- The court adopted a tiered framework for decision-making based on the evidentiary strength of the patient’s wishes:
  - subjective test (patient’s wishes reliably known),
  - limited-objective test (some evidence of wishes plus a clear burdens-over-benefits showing),
  - pure-objective test (no evidence of wishes; withdrawal only if burdens clearly and markedly outweigh benefits with very high certainty).
- The court remanded for application of these standards with careful fact-finding and safeguards, rather than automatically authorizing tube removal on the existing record.

## Legal Principles

- A competent person has a strong common-law and constitutional interest in bodily integrity and privacy that includes refusing medical treatment even if death results; that interest may be exercised for an incompetent person through surrogate decision-making subject to protections.
- Artificial nutrition and hydration delivered through medical means (such as an NG tube) constitute medical treatment, not categorically protected “basic care,” because they require medical skill and entail medical risks and burdens.
- Decision-making standards depend on the degree of proof of the patient’s preferences:
  - Subjective test: withdrawal permitted when reliable evidence shows the patient, if competent, would refuse treatment in the present circumstances.
  - Limited-objective test: withdrawal permitted when there is reasonably trustworthy evidence of likely refusal and it is clear the burdens of continued life with treatment outweigh the benefits to the patient.
  - Pure-objective test: withdrawal permitted only when, without any evidence of preferences, the burdens of continued life with treatment clearly and markedly outweigh benefits, with a very high degree of certainty and irreversibility.
- State interests (preserving life, preventing suicide, protecting third parties, and maintaining medical ethics) do not automatically bar withdrawal in this patient class when evidentiary and procedural safeguards are satisfied.
- Because of heightened risk of abuse for institutionalized, severely impaired elderly patients, close judicial oversight or similarly robust review procedures and demanding evidentiary thresholds are required.

## Conclusion

The court recognized that artificial feeding is medical treatment that may be refused on behalf of an incompetent, institutionalized elderly patient and established a three-part hierarchy—subjective, limited-objective, and pure-objective tests—to determine when withdrawal of life-sustaining treatment is legally permissible under stringent safeguards.


In re Conroy, 98 N.J. 321, 486 A.2d 1209 (N.J. 1985)