## Facts

- Kathleen Farrell, a competent adult, suffered from advanced amyotrophic lateral sclerosis (ALS), a progressive, incurable condition.
- As her disease progressed, she became quadriplegic and required a respirator to breathe.
- ALS did not impair her cognitive function, and she remained able to communicate.
- While living at home on mechanical ventilation, she repeatedly told her husband and sons she wanted the respirator disconnected to end her suffering and allow her to die.
- A психологical evaluation concluded she was not clinically depressed and was competent to make medical decisions.
- Her husband sought a declaratory judgment authorizing withdrawal of the respirator and protecting him and participating medical personnel from criminal liability.
- The trial court granted the requested relief and stayed its order pending appeal.
- During the appeal, Kathleen died while still on the respirator; the Supreme Court of New Jersey decided the case because the issue was likely to recur yet evade review.

## Issues

1. Whether a competent, terminally ill adult has a legal right to refuse or discontinue life-sustaining medical treatment, including a respirator, when death will foreseeably result.
2. Whether that right applies when the patient is receiving life-sustaining treatment at home rather than in an institution.
3. What procedures and protections are required to confirm competence and voluntariness and to protect family members and health-care providers from criminal or civil exposure when implementing the patient’s decision.

## Decision

- The Supreme Court of New Jersey recognized a competent adult’s constitutional and common-law right to refuse life-sustaining medical treatment, including withdrawal of mechanical ventilation.
- The Court held the right applies in non-institutional settings, including a patient’s home.
- The Court concluded that, when adequate procedures confirm competence, informed decision-making, and voluntariness, those who carry out the patient’s decision do not incur criminal liability under New Jersey law.
- Although the patient had died, the Court affirmed the trial court’s legal framework in declaratory form to guide future cases.

## Legal Principles

- A competent adult’s informed-consent rights include the correlative right to decline or discontinue medical treatment, even if the result is death.
- The right is grounded in common-law bodily integrity and constitutionally protected privacy/autonomy interests; the State’s interest in preserving life does not automatically override a competent patient’s refusal.
- Withdrawal of unwanted life-sustaining treatment at a competent patient’s request is legally distinct from suicide or assisted suicide; it permits the underlying disease to take its course rather than causing death by an affirmative lethal act.
- The place of treatment (home versus hospital) does not change the legal analysis, provided there is appropriate medical involvement and documentation.
- Procedural safeguards should include professional assessment of competence (including screening for impairing depression), confirmation the patient is informed of diagnosis/prognosis and alternatives (including palliative options), evidence of voluntariness and consistent expression of choice, and physician documentation of the decision and medical basis.

## Conclusion

The court held that a competent, terminally ill adult may choose to discontinue life-sustaining treatment, including a respirator, even at home, and that family members and clinicians who implement the patient’s informed and voluntary decision pursuant to appropriate safeguards are not subject to criminal liability.


Matter of Farrell, 108 N.J. 335, 529 A.2d 404 (N.J. 1987)