## Facts

- Nancy Ellen Jobes suffered severe brain damage after medical complications following surgery related to an automobile accident while pregnant; the fetus died, and she never regained consciousness.
- She resided in a nursing facility and was found to be in a persistent, irreversible vegetative state with no reasonable medical prospect of cognitive recovery.
- Nancy did not require a respirator but received artificial nutrition and hydration through a surgically implanted gastrostomy tube.
- Before becoming incompetent, Nancy made informal oral statements to family and friends indicating she would not want to be kept alive in a vegetative condition, referencing the widely known Quinlan situation.
- Nancy’s husband, supported by her parents, sought authorization to discontinue artificial nutrition and hydration based on what they believed Nancy would have chosen.
- The nursing facility opposed withdrawal and requested appointment of an independent “life advocate” to represent an interest in preserving life.

## Issues

1. What evidentiary showing is required to establish that an incompetent patient is in a persistent, irreversible vegetative state with no reasonable possibility of recovery to a cognitive, sapient state.
2. Whether the right to refuse life-sustaining medical treatment persists after incompetence and may be exercised by family or a close friend under substituted judgment.
3. What procedural safeguards and decision-making structure should govern withdrawal of artificial nutrition and hydration from a nursing-home patient in a persistent vegetative state.
4. Whether a nursing facility may refuse to participate in withdrawal in a manner that effectively prevents implementation of a lawful surrogate decision.

## Decision

- The New Jersey Supreme Court modified and affirmed the trial court’s order authorizing withdrawal of artificial nutrition and hydration.
- The Court upheld the finding that Nancy Jobes was in a persistent, irreversible vegetative state.
- The Court held that the patient’s right to refuse life-sustaining treatment continues after incompetence and may be exercised by family or a close friend using substituted judgment.
- The Court required confirmation by at least two independent physicians knowledgeable in neurology that the patient is in a persistent vegetative state and has no reasonable possibility of recovery to a cognitive, sapient state.
- The Court held the nursing facility could transfer the patient to another willing provider but could not block withdrawal by keeping the patient connected pending transfer.

## Legal Principles

- A competent person’s right to refuse life-sustaining medical treatment survives incompetence and may be implemented through substituted judgment by appropriate surrogates.
- Courts generally do not make the underlying treatment choice; their role is to set protective criteria and provide review to safeguard incompetent patients.
- Artificial nutrition and hydration delivered through a feeding tube constitutes medical treatment that may be refused under the same autonomy-based framework as other life-sustaining interventions.
- Withdrawal of life-sustaining treatment from a patient in a persistent vegetative state requires heightened medical safeguards, including independent neurologically informed confirmation of diagnosis and prognosis.
- Health-care institutions may assert conscience-based objections by arranging transfer, but they may not exercise a de facto veto that nullifies an authorized surrogate decision.

## Conclusion

The court authorized withdrawal of a feeding tube from a patient in a persistent, irreversible vegetative state, holding that the patient’s autonomy interest persists after incompetence and may be exercised by family under substituted judgment, subject to independent neurologically informed medical confirmation and without an institutional veto that would prevent implementation.


In re Jobes, 529 A.2d 434 (N.J. 1987)