New Jersey: Appellate Court Issues Ruling in Betancourt v. Trinitas

The Appellate Division of the New Jersey Superior Court issued its ruling today in Betancourt v. Trinitas Hospital.  The hospital had asked the Court to rule that it had the right to discontinue dialysis treatments for Ruben Betancourt, a patient with a hypoxic brain injury, based on doctors' claims that prolonging his life was "futile" and "inhumane" because his life lacked "dignity," in part due to his brain injury and in part due to his overall poor state of health, and his age -- 73.

Not Dead Yet filed an amicus brief along with ADAPT, Center For Self-Determination, National Council On Independent Living, National Spinal Cord Injury Association, American Association of People With Disabilities and Disability Rights of New Jersey.

Here is what our lawyer, Anne Studholme, said upon reading the decision:

Not Dead Yet led a consortium of disability rights organizations in filing a friend-of-the-court brief and participating in oral argument when the case was heard on April 27, 2010.  We reminded the Court of the significance of New Jersey's historic prior jurisprudence on issues of personal medical autonomy, and described how the concept of "futility" devalues the lives of people with disabilities.

The case had been brought to the Appellate Division by Trinitas Hospital, which had lost at trial.  The trial court found in favor of Mr. Betancourt's autonomy, finding that his daughter had offered evidence as to her father's wishes and would be a faithful guardian in carrying out his desires under New Jersey's concept of surrogate decisionmaking.

The day before the hospital's appellate brief was due to be filed, on May 29, 2009, Mr. Betancourt died.  His family asked the Court to dismiss the case as moot.  We joined in that motion, in part because of our concern that it might be too easy for a court to overlook the individuality of the person at the heart of the case if he was already dead.  It would also be too easy to dismiss him as 'dying.'  We also feel that the Court acknowledged our concern that this case risked conflating mentally incapacitated people with people whose doctors describe them as 'dying.'  People in both situations are vulnerable to having their lives declared futile.

The court agreed that Mr. Betancourt's death rendered the case moot, and that for other reasons to do with idiosyncrasies of the facts and the record, it would not be reviewed under the narrow exceptions which permit review of moot cases.  The Court quoted our brief: that Betancourt's "death 'casts an aura of hindsight wisdom over the doctors' declarations that he was "dying[]" ' and makes this a poor case in which to adjudicate the rights of mentally incapacitated individuals."

This distinguished appellate panel gave the matter appropriate attention, handing down a 26-page opinion.  Had the merits been reached, five New Jersey Supreme Court opinions would have given strong guidance to this intermediate court, and even at the higher level were the case to proceed there. 

"Unlike Conroy and Farrell [two of the five prior NJ Supreme Court decisions protecting medical autonomy], the uncertainties as to Ruben's condition and prognosis do not lend themselves to the resolution of the important issue involved here. A decision here may be applicable not only to a patient on the threshold of death but also to a mentally incapacitated, yet stable, patient. Such a decision would neither serve the interests of the parties here nor the public at large. Vague decisions based on unique facts do not lend themselves to the type of resolution required here."

The Court acknowledged the high public importance of the issues raised, and invited legislative consideration and administrative policy-making.  As we said at oral argument, legislative fact-finding can help illuminate the issues, but it is also important that the courts stand as the bulwark to protect the rights of politically vulnerable people.

So - basically, this ruling makes it a pretty good Friday the 13th for us.

For more info, commentary and coverage:

Thaddeus Pope, who also filed an amicus brief in the case, has shared his initial analysis of the decision on his Medical Futility Blog.


The New Jersey Star-Ledger has coverage of the ruling.

NJ Today also has a story about the ruling.


The ruling itself can be read here in pdf format.


For any member of the media wanting comment on the case:

Contact info for Anne Studholme:
Tel: (609) 945-3955
Cell:  (609) 651-6211
Fax: (609) 935-0567

(space inserted in email as a spam precaution)
anne @manewitzstudholme.com
anne @alumni.princeton.edu