## Facts

- Michael Martin suffered catastrophic injuries in a 1987 automobile–train collision, leaving him severely cognitively and physically impaired.
- He was conscious, not terminally ill, and not in a persistent vegetative state; his cognitive deficits could not be reliably evaluated.
- Michael received nutrition and hydration through a gastrostomy (feeding) tube.
- Mary Martin, Michael’s wife and court-appointed guardian and conservator, petitioned to remove the feeding tube based on Michael’s alleged pre-injury statements about not wanting life-sustaining treatment in comparable circumstances.
- Michael’s mother and sister opposed removal, arguing the evidence of Michael’s wishes was unreliable, generalized, and insufficiently specific to his condition and the treatment at issue.
- The probate court found clear and convincing evidence of Michael’s prior treatment preference and authorized withdrawal; the court of appeals affirmed.

## Issues

1. Whether a guardian may authorize removal of a gastrostomy feeding tube from a conscious, nonterminal, non–persistent vegetative state patient based on substituted judgment.
2. Whether the record contained clear and convincing evidence that, while competent, the patient made a firm and deliberative decision to refuse the specific life-sustaining treatment under circumstances substantially similar to those presented.

## Decision

- The Michigan Supreme Court reversed the court of appeals.
- The Court held the evidence did not clearly and convincingly prove that Michael, while competent, made a firm and deliberative decision to refuse a gastrostomy feeding tube in circumstances like his present condition.
- Because the evidentiary standard was not met, withdrawal of the feeding tube was not authorized.

## Legal Principles

- Michigan recognizes a competent person’s right to refuse life-sustaining medical treatment as part of the common-law doctrine of informed consent.
- When a patient is incapacitated, substituted judgment may be used to effectuate the patient’s own treatment choice, but only when the choice is established by clear and convincing evidence.
- The clear-and-convincing standard requires proof that the patient’s prior statements or actions reflect a firm and deliberative decision applicable to the specific treatment and circumstances at issue, not merely generalized expressions about severe disability or “machines.”
- In cases involving a conscious patient who is neither terminally ill nor in a persistent vegetative state, and where the patient’s subjective experience cannot be reliably assessed, strong state interests in protecting life and vulnerable persons justify a rigorous evidentiary threshold.
- Where the proof is uncertain, the court should resolve the matter in favor of preserving life because the decision to end life-sustaining treatment is irreversible.

## Conclusion

The Michigan Supreme Court held that, although a person has a common-law right to refuse life-sustaining treatment, a guardian may not withdraw tube-provided nutrition and hydration from a conscious, nonterminal incapacitated patient absent clear and convincing evidence of the patient’s firm, deliberative prior decision to refuse that specific treatment in substantially similar circumstances.


In re Martin, 450 Mich. 204, 538 N.W.2d 399 (Mich. 1995)