## Facts

- S.S. suffered from severe obesity that caused serious respiratory problems.
- In 2006, S.S. was hospitalized at South Nassau Communities Hospital, was temporarily placed on a respirator, and underwent a tracheotomy.
- After discharge, S.S. continued follow-up care with a hospital physician (Dr. A) because of ongoing breathing issues.
- At an office visit, Dr. A discussed possible future consequences of S.S.’s obesity, including long-term respirator use.
- S.S. responded emphatically that he did not want to live on a respirator or receive artificial nutrition through a feeding tube; he said he had seen others living that way and would rather die than live like that.
- Dr. A suggested that S.S. execute a New York health care proxy. S.S. did so, naming his wife, R.S., as his health care agent.
- At S.S.’s direction, R.S. completed the form and wrote “I wish to live” in the optional instructions section, while S.S. reiterated he wanted to live “on his own terms.”
- Later, S.S. suffered a heart attack that caused severe brain damage and left him unable to make medical decisions.
- As S.S.’s agent, R.S. refused placement of a feeding tube for life-sustaining artificial nutrition.
- S.S.’s siblings, S.I. and F.H., devout Orthodox Jews who believed life must be prolonged, filed a proceeding seeking to void R.S.’s appointment and to have F.H. appointed as guardian, alleging R.S. was not acting in S.S.’s best interests and was influenced by the cost of care.
- The siblings admitted S.S. was not an Orthodox Jew and that they had not discussed S.S.’s specific wishes about respirators or feeding tubes with him.
- Dr. A and R.S. testified about the proxy-execution conversation and other similar statements by S.S. indicating he did not want to be kept alive by a ventilator or tube feeding.

## Issues

1. Whether the court should void or set aside S.S.’s health care proxy appointing R.S. as agent and instead appoint F.H. as guardian to direct care.
2. Whether R.S., acting as the duly appointed health care agent, had authority to refuse insertion of a feeding tube for artificial nutrition and hydration after S.S. lost capacity.
3. How the instruction “I wish to live” on the proxy form should be read in light of evidence that S.S. repeatedly rejected long-term ventilator dependence and tube feeding.

## Decision

- The court denied the siblings’ request to void the health care proxy and denied the request to appoint F.H. as guardian.
- The court left R.S. in place as S.S.’s health care agent and permitted the hospital to rely on her medical decisions.
- The court credited the testimony of Dr. A and R.S. regarding S.S.’s repeated statements that he did not want a respirator or feeding tube and wanted to live only “on his own terms.”
- The court rejected the siblings’ contention that “I wish to live” required continuation of all possible life-prolonging treatment in disregard of S.S.’s stated limits.
- The court found the siblings’ religious objections and unsupported claims about financial motive were not a sufficient basis to remove the chosen agent or override the patient’s expressed wishes.

## Legal Principles

- A properly executed New York health care proxy appointing a health care agent remains effective after the principal loses decision-making capacity, and the agent may make health care decisions for the principal within the scope of the appointment.
- Courts are reluctant to remove or bypass a chosen health care agent absent a strong showing that the proxy is invalid, the agent is acting in bad faith, or the agent’s decisions conflict with the patient’s known wishes.
- When a patient’s prior statements about life-sustaining treatment are shown through credible testimony, those statements guide interpretation of brief or general written phrases on a proxy form.
- Family members’ moral or religious preferences do not control treatment decisions when they conflict with the patient’s own expressed choices, especially where the family cannot show the patient shared those views or made statements supporting the requested treatment.

## Conclusion

S.I. & F.H. v. R.S. & South Nassau Communities Hospital held that S.S.’s wife, as his duly appointed health care agent, could refuse a feeding tube when credible evidence showed S.S. had clearly and repeatedly said he did not want to live on a respirator or by artificial feeding, and the court would not void the proxy or appoint a guardian based on the siblings’ religious objections or speculative allegations about cost.


S.I. & F.H. v. R.S. & South Nassau Communities Hospital, 877 N.Y.S.2d 860 (2009)