## Facts

- John Storar, age 52, had been profoundly intellectually disabled since birth, with a mental age of about 18 months, and lived most of his life in a state developmental center.
- Storar developed bladder cancer; after recurrence, physicians determined the condition was terminal.
- Bladder lesions caused ongoing blood loss; without blood transfusions, Storar would likely die relatively soon from exsanguination, though transfusions would not cure the cancer.
- Transfusions could prolong life for a limited time; experts agreed Storar had only a short time to live with or without transfusions.
- Storar was incapable of understanding his condition or making medical decisions; he resisted transfusions and appeared distressed, though the procedures were performed with sedation and were not shown to cause excessive pain.
- Dorothy Storar, Storar’s mother and court-appointed guardian, initially consented to transfusions but later withdrew consent, seeking to stop procedures she viewed as burdensome and prolonging suffering.
- The facility director petitioned for authorization to continue transfusions over the guardian’s objection; the guardian cross-petitioned to halt treatment.
- The trial court denied the facility’s request and the intermediate appellate court affirmed; the New York Court of Appeals granted review (the matter was reviewed despite mootness because the issue was capable of repetition yet evading review).

## Issues

1. Whether a guardian of a person who has been mentally incompetent for life may withhold or withdraw consent to life-sustaining treatment based on the guardian’s assessment of the patient’s best interests when the patient never had capacity to express treatment preferences.

## Decision

- The New York Court of Appeals reversed the lower courts and authorized continuation of blood transfusions.
- The court held that a guardian of a lifelong incompetent person may not withhold life-saving medical treatment based on a belief that doing so is in the patient’s best interests.
- The court treated the transfusions as ordinary life-preserving care that directly prevented imminent death from blood loss, not extraordinary measures.
- The patient’s terminal cancer prognosis did not justify allowing a guardian to refuse routine treatment that would avert imminent death.

## Legal Principles

- A lifelong incompetent patient has no prior autonomous treatment choice to implement through substituted judgment; surrogate “what the patient would have wanted” determinations are inherently speculative in that setting.
- A guardian may not withhold ordinary, life-saving medical treatment from a lifelong incompetent patient solely on a best-interests rationale.
- The state’s interest in preserving life and protecting vulnerable persons who cannot speak for themselves weighs heavily against authorizing cessation of ordinary life-preserving care for lifelong incompetents.
- Discomfort or resistance to treatment, without proof of excessive pain or extraordinary burden, does not convert routine life-saving care into treatment that a guardian may refuse on the patient’s behalf.

## Conclusion

The court required continuation of blood transfusions for a terminally ill patient who had been incompetent for life, holding that a guardian cannot refuse ordinary life-saving treatment on a best-interests theory where the patient never had capacity to form or express treatment preferences.


In re Storar, 420 N.E.2d 64 (N.Y. 1981)