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02/11/88 In Re Estate of Virginia T. Prange

February 11, 1988

IN RE ESTATE OF VIRGINIA T. PRANGE


APPELLATE COURT OF ILLINOIS, FIRST DISTRICT, FOURTH DIVISION 1988.IL.182

520 N.E.2d 946, 166 Ill. App. 3d 1091, 117 Ill. Dec. 595

Appeal from the Circuit Court of Cook County; the Hon. Miriam E. Harrison, Judge, presiding

Rehearing denied March 24, 1988

DECISION OF THE COURT DELIVERED BY THE HONORABLE JUDGE JIGANTI

Patrick T. Murphy, the public guardian of Cook County, initiated this action by petitioning the trial court for an order directing the discontinuance of artificial means of providing nutrition and hydration to the guardian's ward, Virginia T. Prange, who was in a persistent vegetative state from which she was not expected to recover. The petition indicated that when Virginia Prange was competent, she stated both in writing and in conversations with her friends that she did not wish to be kept alive by artificial means if there was no hope of recovery. The court appointed a guardian ad litem to represent the opposing position and a hearing was held. Following the hearing, but before a decision was rendered, Virginia Prange died. The court dismissed the matter as moot and the public guardian has appealed. The issue before us is whether artificial means of providing nutrition and hydration could properly be withdrawn from a patient in a persistent vegetative state who, prior to her incompetency, had clearly expressed the desire not to be maintained in that condition.

On motion of the public guardian, this court appointed Margaret C. Benson of the Chicago Volunteer Legal Services Foundation to file an appellee's brief representing the opposing position on appeal. We also permitted the participation as amici curiae of the Society for the Right To Die, Inc., the Americans United for Life Legal Defense Fund, the Catholic League for Religious and Civil Rights and the Ethics and Advocacy Task Force of the Nursing Home Action Group.

Virginia Prange was a 74-year-old woman who had undergone seven surgeries over the past several years to remove a persistent brain tumor. She had no close relatives and resided in a nursing home after her last surgery in December 1985. In January 1986, Prange lapsed into what her attending physician characterized as a persistent vegetative state. She was unable to interact with her environment and did not respond purposefully to stimuli. A nasogastric tube was inserted in order to provide her with nutrition and hydration.

The public guardian was appointed as plenary guardian of Virginia Prange, and on October 30, 1986, he filed a petition regarding medical consent. In the petition, the public guardian stated that he had refused consent for a surgical procedure and blood transfusions and asked the court to ratify those decisions. The petition further requested that the court direct the public guardian to remove the nasogastric tube, thereby discontinuing artificial means of providing nutrition and hydration to Virginia Prange. Attached to a memorandum accompanying the petition was the following statement signed by Virginia Prange:

"To My Family, My Physician, My Lawyer, and All Others Whom It May Concern:

Death is as much a reality as birth, growth, maturity and old age -- it is the one certainty of life. If the time comes when I can no longer take part in decisions for my own future, let this statement stand as an expression of my wishes and directions, while I am still of sound mind.

If at such time the situation should arise in which there is no reasonable expectation of my recovery from extreme physical or mental disability, I direct that I be allowed to die and not be kept alive by medications, artificial means, or 'heroic measures.' I do, however, ask that medication be mercifully administered to me to alleviate suffering, even though this may shorten my remaining life.

This statement is made after careful consideration and is in accordance with my strong convictions and beliefs. I want the wishes and directions here expressed carried out to the extent permitted by law. Insofar as they are not legally enforceable, I hope that those to whom this Will is addressed will regard themselves as morally bound by these provisions."

This statement was apparently drafted according to the specifications of the Illinois Living Will Act (Ill. Rev. Stat. 1985, ch. 110 1/2, par. 701 et seq., (recently amended by Pub. Act 85-860, eff. Jan. 1, 1988)), which provides a mechanism for persons, while competent, to make decisions relating to their medical care in the event of a terminal illness. Virginia Prange's statement was not a valid "living will," however, because it lacked the requisite number of witnesses.

At a hearing on the petition, the public guardian introduced the testimony of five persons who were close friends of Virginia Prange. Monsignor Joseph Howard testified that in 1985, Prange told him that she wanted no further operations and that she would rather die than have her life prolonged by artificial or extraordinary means. Eleanor Jennings, who witnessed the above-quoted "living will" written by Prange, stated that Prange told her she did not want to be kept alive by "tube feeding" and would rather "close her eyes and die." Barbara Knuth, Prange's second cousin, testified that she had discussed the topic of death with Prange and that Prange told her that she did not want to live in a nursing home and that she wished to "die with dignity." Two other witnesses, Sister Mary Ann McSweeney and Terese Barlow, testified that based upon their ...


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