## Facts

- Charlotte F. Tavel, age 88, suffered a severe stroke in 1992, leaving her largely paralyzed and virtually unresponsive.
- She resided in a nursing facility and eventually received artificial nutrition and hydration through a feeding tube when her ability to eat declined.
- Medical evidence indicated she was in a persistent vegetative state with no reasonable likelihood of neurological recovery and suffered serious complications, including seizures and skin ulcers.
- Mrs. Tavel had not executed a written advance directive under Delaware’s Death with Dignity Act.
- Her daughter, Barbara Tavel-Lipnick, was appointed guardian of the person and believed Mrs. Tavel would not want life prolonged indefinitely by artificial feeding given her condition and prior values.
- The Court of Chancery appointed an attorney ad litem to represent Mrs. Tavel’s independent interests; after investigation, the attorney ad litem supported the guardian’s request.
- The State of Delaware opposed the petition and appealed after the Court of Chancery authorized withdrawal of the feeding tube.

## Issues

1. Whether Delaware’s Death with Dignity Act provides the exclusive procedure for withdrawing life-sustaining treatment from an incompetent person who lacks a written advance directive.
2. Whether the evidence met the clear and convincing standard that Mrs. Tavel would have chosen withdrawal of artificial nutrition and hydration under the circumstances.
3. Whether an attorney ad litem for an incapacitated person must oppose withdrawal of life-sustaining treatment and advocate solely for continued life.

## Decision

- The Delaware Supreme Court affirmed the Court of Chancery’s order authorizing removal of the feeding tube.
- The Death with Dignity Act was held not to be the exclusive mechanism for end-of-life decisions; equitable guardianship authority remained available.
- The record supported the finding, by clear and convincing evidence, that Mrs. Tavel would have refused continued artificial nutrition and hydration in her condition.
- The attorney ad litem acted properly by joining the guardian’s petition after concluding, through independent investigation, that withdrawal served the ward’s interests and likely wishes.

## Legal Principles

- Delaware’s Death with Dignity Act supplements, rather than displaces, the Court of Chancery’s equitable authority in guardianship matters to determine medical treatment for incompetent persons.
- A court may authorize withdrawal of life-sustaining treatment for an incapacitated adult when there is clear and convincing evidence that the patient would have refused the treatment under the circumstances (substituted judgment).
- An attorney ad litem represents the ward’s interests and may support withdrawal of treatment when the attorney reasonably concludes, after investigation, that doing so aligns with the ward’s likely wishes or welfare; the role is not to assert a categorical position favoring continued life.

## Conclusion

The court upheld judicial authorization for a guardian to withdraw artificial nutrition and hydration from an incapacitated patient in a persistent vegetative state, holding that the statutory advance-directive scheme was not exclusive, that the patient’s likely choice had to be proved by clear and convincing evidence, and that an attorney ad litem may support withdrawal when consistent with the ward’s interests and probable wishes.


In re Tavel, 661 A.2d 1061 (Del. 1995)