In the Matter of Charlotte F. Tavel

Charlotte Tavel was a vibrant, active, and dignified person. In 1992, 88-year-old Tavel had a severe stroke that left half her body paralyzed and the other virtually unresponsive. She was moved into a nursing center. When her ability to eat declined, the center obtained permission from Tavel’s daughter, Barbara Tavel-Lipnick (plaintiff), to insert a feeding tube. Over time, Tavel’s condition deteriorated. Although she initially showed some responsiveness to Tavel-Lipnick and friends, she became unresponsive and noncommunicative, existing in a persistent vegetative state. She also suffered from seizures, skin ulcers, and incontinence. Doctors advised there was no hope for improvement. Tavel-Lipnick, who had been appointed as Tavel’s guardian, believed that Tavel would not want to live like that. Consequently, three and a half years after the stroke, Tavel-Lipnick petitioned for permission to remove the feeding tube and let Tavel die. The court appointed an attorney ad litem to assess and represent Tavel’s interests. The attorney concluded that removing the tube was in Tavel’s best interests and joined Tavel-Lipnick’s petition. The state opposed the petition, arguing that permission to remove the tube should be denied because (1) Tavel did not execute an advance directive under Delaware’s Death with Dignity Act, which the state claimed established the exclusive procedures for terminating an incompetent person’s medical treatment; (2) even if the act’s procedures were not exclusive, Tavel-Lipnick had failed to present clear and convincing evidence Tavel would want the tube removed; and (3) the attorney ad litem should have been required to advocate for keeping Tavel alive. The trial court granted Tavel-Lipnick’s petition. The state appealed.