Patient Center Advance Medical Directives Discussion of Two Recent Wisconsin Court Cases, "Edna MF" and "Montalvo"

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By W. J. Hisgen, M.D., Chair, Meriter Ethics Advisory Group and Ralph V. Topinka, Atty., Quarles and Brady, LLP.
Written to Meriter Medical Staff Members on April 29, 2003.


Two recent Wisconsin court cases, In the Matter of Guardianship of Edna MF (Wisconsin Supreme Court Decision, 1997) and Montalvo v. Borkovec, Wisconsin Court of Appeals Decision (2002), set restrictions on withholding and withdrawing life-sustaining treatment for certain patients.

The "Edna" case involved an elderly patient with a court-appointed guardian; the "Montalvo" case involved a premature newborn infant. Neither patient had an advance directive. In "Edna," the Wisconsin Supreme Court ruled that life-sustaining treatment could not be withdrawn unless the patient was determined to be in a persistent vegetative state. However, in ruling on this case, the Court also stipulated that any verbal or written statement of a person's end of life wishes would carry the same legal weight as the officially sanctioned medical directives. In "Montalvo," an intermediate appellate court made a similar ruling, asserting that parents could not consent to withholding life-sustaining treatment from a child who was not in a persistent vegetative state.

These cases have raised questions among some physicians as to whether they can make a collaborative decision with next of kin to limit life-sustaining treatment when further treatment does not appear to be serving the interests of an incompetent patient. Since these decisions appear to contradict well-established and widely accepted standards of care for patients with life-threatening conditions, their implications for medical practice are unclear.

The Meriter Ethics Advisory Group, with the agreement of the hospital attorney, recommends that physicians continue to practice medicine guided by the interests of the patient, in collaboration with next of kin and other providers, relying on long-established ethical and legal principles as described in the Guidelines Regarding Decisions to Withhold, Use or Withdraw Life-Sustaining Treatment (PDF File). As stated in the Guidelines, when there are disagreements or uncertainty regarding the ethical or legal appropriateness of a management plan, consultation with the Ethics Advisory Group or hospital attorney is recommended.

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9/1/2005