Case Scenario: Mr. Martin sustained debilitating injuries as the result of an automobile accident. He suffered severe subcortical brain damage, significantly impairing his physical and cognitive functioning. 56 His injuries left him totally paralyzed on the left side. He could not speak or eat and had no bladder or bowel control. Martin remained conscious and had some awareness of his surroundings. He could communicate to a very minimal degree through head nods. The trial court determined that Martin did not have nor would he ever have the ability to have the requisite capacity to make decisions regarding the withdrawal of life-support equipment. The evidence demonstrated that Martin's preference would have been to decline life-support equipment given his medical condition and prognosis. The trial court's decision was based on the following four-part test for determining whether a person has the requisite capacity to make a decision: Does the person have sufficient mind to reasonably understand the condition? Is the person capable of understanding the nature and effect of the treatment choices?

Is the person aware of the consequences associated with those choices? Is the person able to make an informed choice that is voluntary and not coerced? The trial court also determined that Mrs. Martin, the patient's spouse, was a suitable guardian for him. Mrs. Martin petitioned to withdraw her husband's life support. Martin's mother and sister counterpetitioned to have Mrs. Martin removed as the patient's guardian. The Michigan Court of Appeals held that the evidence was sufficient to support a finding that the patient lacked capacity to make decisions regarding the withholding or withdrawal of life-sustaining treatment. As to the patient's desire not to be placed on life-support equipment, there was sufficient evidence to show that the patient had a medical preference to decline treatment under circumstances such as those that occurred.

There was also sufficient evidence to show that the patient's spouse was a suitable guardian. The test for determining whether Martin had the requisite capacity to make a decision regarding the withholding or withdrawal of life-supporting medical treatment was clear and convincing-he did not have sufficient decision-making capacity. The evidence was just as clear that he never would regain sufficient decision-making capacity that would enable him to make such a decision. It was the general consensus of all of the experts that Martin's condition and cognitive level of functioning would not improve in the future. Testimony from two of Martin's friends described statements made by him that he would never want to be maintained in a coma or in a vegetative state. In addition, Mrs. Martin described numerous statements made to her by Martin prior to the accident that he would not want to be maintained alive, given the circumstances described previously here. The trial court found that Mrs. Martin was credible. The court of appeals found no reason to dispute the trial court's finding as to Mrs. Martin's credibility. In contrast to allegations made by the patient's mother and sister, the evidence was clear that Mrs. Martin's testimony was credible. There was no evidence that Mrs. Martin had anything but her husband's best interest at heart. There were allegations, but no evidence, that financial considerations or pressure from another individual influenced Mrs. Martin's testimony

Ethical and Legal Issues

1. Knowing that the patient had some ability to interact with his environment, discuss the four-part test for determining the patient's ability to make a decision.

2. Do you agree with the court's decision? Explain.

3. Should the concern of the mother and sister have carried more weight in removing custody from Mrs. Martin?

4. What influence do you believe the mother and sister might have had on Mrs. Martin?