In Re Estate of Greenspan

558 N.E.2d 1194, 137 Ill. 2d 1, 146 Ill. Dec. 860, 1990 Ill. LEXIS 82
CourtIllinois Supreme Court
DecidedJuly 9, 1990
Docket67903
StatusPublished
Cited by49 cases

This text of 558 N.E.2d 1194 (In Re Estate of Greenspan) is published on Counsel Stack Legal Research, covering Illinois Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
In Re Estate of Greenspan, 558 N.E.2d 1194, 137 Ill. 2d 1, 146 Ill. Dec. 860, 1990 Ill. LEXIS 82 (Ill. 1990).

Opinions

JUSTICE STAMOS

delivered the opinion of the court:

In this cause, Patrick T. Murphy, as public guardian of Cook County and guardian of the person of Sidney Greenspan, appeals from denial by the circuit court of Cook County of his petition for leave to order the discontinuance of artificial feeding and hydration of Mr. Greenspan. We vacate and remand.

On October 5, 1988, upon petition by the public guardian, the circuit court appointed him as plenary guardian of the person of Mr. Greenspan. The public guardian’s petition to terminate Mr. Greenspan’s life-support systems was filed on October 11, 1988, and on October 12 the circuit court appointed Andrew R. Gelman as guardian ad litem to protect Mr. Greenspan’s interests in connection with that petition. On October 21, the circuit court denied a motion by the guardian ad litem to strike and dismiss the petition on the grounds that the public guardian lacked standing, and the public guardian filed an amended petition to reflect the length of time that Mr. Greenspan had been in his current medical condition. On November 2, 1988, the circuit court denied the public guardian’s amended petition. The public guardian appealed to the appellate court. We then ordered the appeal taken directly to us under Supreme Court Rule 302(b) (107 Ill. 2d R. 302(b)).

I. FACTS

Mr. Greenspan, then a 76-year-old Chicago resident, suffered a stroke in November 1984, which resulted in the death of areas of his brain cells, left him unconscious, and is irreversible. In 1983, Mr. Greenspan had also been diagnosed as suffering from an organic brain syndrome, a senile dementia of the Alzheimer’s type that was becoming increasingly acute. In December 1984, Mr. Greenspan became a nursing home resident. Mr. Greenspan has no dependent relatives or children, though his wife and adult children are living.

Mr. Greenspan has never executed a living will or a health care power of attorney. In fact, the Illinois Power of Attorney Act (Ill. Rev. Stat. 1987, ch. 110½, par. 801 — 1 et seq.), which provides for such health care powers, did not become effective until 1987, although the Illinois Living Will Act (Ill. Rev. Stat. 1987, ch. 110½, par. 701 et seq.) became effective on January 1, 1984.

Medical testimony tends to prove that, for some five years now, Mr. Greenspan has been in a chronic vegetative state, meaning that he retains only the primitive cortical brain functions that regulate breathing and some other basic life processes separate from consciousness. There is no reasonable hope that he will recover from his condition. He lies in a fetal position, with severe muscular contracture, and with a nasogastric (artificial feeding) tube inserted through one of his nostrils.

At the hearing on the public guardian’s petition, Dr. Allan Burke, a consulting physician, testified regarding Mr. Greenspan’s medical condition and regarding medical ethics applicable to his case. In addition, a stipulation was received as to testimony of Mr. Greenspan’s current attending physician, Dr. Charles Schikman, regarding Mr. Greenspan’s condition. Dr. Steven H. Miles testified on medical ethics in cases such as Mr. Greenspan’s. Mr. Greenspan’s wife, two of his children, and a longtime employee of Mr. Greenspan testified regarding Mr. Greenspan’s beliefs about being artificially maintained if one is completely incapacitated.

A. Medical Testimony

Dr. Burke. The testimony of Dr. Allan Burke, who examined Mr. Greenspan and is a board-certified neurologist and assistant professor of clinical neurology at Northwestern University, was as follows.

Mr. Greenspan makes no eye contact with other persons and does not respond to stimuli, including painful stimuli. Electroencephalography confirms the lack of response. Mr. Greenspan is incapable of any cognitive functioning or of feeling pain. If he were able to feel pain, he would feel marked pain because of the perpetual muscle contractures resulting from his brain injuries. Medical tests indicate that, as evidenced by shrinkage resulting from the death of brain cells during the years of Mr. Greenspan’s artificial nutrition and hydration, the Alzheimer’s-type disease is still progressively damaging Mr. Greenspan’s brain, in addition to the damage originally wrought by his stroke. The medical literature contains no documented case history in which a patient recovered from a condition such as Mr. Greenspan’s. Dr. Burke consulted Mr. Greenspan’s medical records, his previous and current attending physicians, and a previous consulting physician; they all corroborated his findings.

If Mr. Greenspan had suffered his illness and stroke in earlier decades, he would soon have died from their effects. His death is prolonged now because of advances in artificial nutrition and hydration. Mr. Greenspan is terminally ill in the sense that his illness would have been terminal if current means of keeping him alive were unavailable. If Mr. Greenspan’s artificial food and water were discontinued by removal of his feeding tube, he would die within a week at most. Such death would result from the combination of his terminal condition generally and one of its specific results, his inability to swallow. By contrast, 17 years is the record period for a patient’s remaining in a chronically vegetative state with the aid of a feeding tube before dying. Analgesics could be given to relieve any pain associated with withdrawal of the feeding tube, but Mr. Greenspan shows no ability to feel any pain from any source.

It is consistent with sound medical practice and medical ethics to remove Mr. Greenspan’s feeding tube, and its continued use “not only does nothing to reverse the injury of the brain, but actually allows the disease to continue so that the dying out of brain cells is continuing.”

(The guardian ad litem later stated to the trial court that he had attempted to find a physician who would testify in support of a position different from Dr. Burke’s but that he had been unable to do so. The American Medical Association as amicus advises this court that, in circumstances resembling those alleged here, withdrawal of artificial nutrition and hydration is ethically sound. However, the American Academy of Medical Ethics and various physicians as amici advise us of their view that deciding to withdraw artificial nutrition and hydration is not a matter of peculiarly scientific or medical competence, that there is no clear medical consensus supporting such withdrawal, and that proffered justifications for such withdrawal rest on no principle that could be limited to patients who are in a persistent vegetative state rather than extending to those who suffer from related dementing processes.)

Dr. Schikman. The parties stipulated that Dr. Charles Schikman, a board-certified internist who was then Mr. Greenspan’s treating physician and had been for the previous three years, would testify that he concurred with Dr. Burke’s findings and recommendation for removing the feeding tube.

Dr. Miles. Dr. Steven H. Miles testified on medical ethics. He is a practicing geriatrician, a board-certified internist, an assistant professor of internal medicine, and the associate director of the Center for Clinical Medical Ethics at the University of Chicago.

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Bluebook (online)
558 N.E.2d 1194, 137 Ill. 2d 1, 146 Ill. Dec. 860, 1990 Ill. LEXIS 82, Counsel Stack Legal Research, https://law.counselstack.com/opinion/in-re-estate-of-greenspan-ill-1990.