Conservatorship of Wendland, 26 Cal. 4th 519, 28 P.3d 151 (Cal. 2001) (Supreme Court of California)
Conservatorship of Wendland is a landmark California Supreme Court decision addressing when a surrogate decisionmaker may lawfully withdraw life-sustaining treatment—specifically artificial nutrition and hydration—from a conscious but severely cognitively impaired adult who lacks decision-making capacity and has left no formal advance directive. The court reconciled the state's statutory framework for surrogate medical decisions with constitutional interests in life and personal autonomy, articulating a heightened evidentiary standard designed to protect especially vulnerable patients from irreversible decisions not demonstrably aligned with their wishes.
May a conservator, acting under California Probate Code section 2355 and related law, withdraw artificial nutrition and hydration from a conscious, incompetent adult who lacks an advance directive absent clear and convincing evidence that withdrawal is consistent with the conservatee's wishes?
While artificial nutrition and hydration is medical treatment that may be refused, a conservator's authority to make medical decisions under Probate Code section 2355 (and the Health Care Decisions Law) must be exercised consistently with the conservatee's known wishes and values. For a conscious conservatee who is not in a persistent vegetative state and not terminally ill, due process and the state's compelling interest in the preservation of life require clear and convincing evidence that the conservatee would decline artificial nutrition and hydration under the circumstances before a court may authorize a conservator to withdraw that treatment. A generalized best-interest determination, or vague, casual, or equivocal prior statements, is insufficient.
The Supreme Court of California affirmed the Court of Appeal, holding that a conservator may not withdraw artificial nutrition and hydration from a conscious, incompetent conservatee without clear and convincing evidence that the decision reflects the conservatee's own wishes. On the record presented, that standard was not met.
Wendland establishes in California that, for conscious but incapacitated patients without an advance directive, life-ending withdrawal of artificial nutrition and hydration requires clear and convincing evidence of the patient's own wishes. The decision narrows the scope of surrogate authority recognized in earlier PVS cases and emphasizes the constitutional and ethical imperative to align end-of-life choices with the patient's values rather than a surrogate's best-interest assessment alone. For law students, Wendland is essential for understanding how courts balance autonomy, evidentiary standards, and the state's interests in medical decision-making, and it underscores the practical importance of advance directives and properly documented patient preferences.