In 1979 Claire Conroy was suffering from an organic brain syndrome that manifested itself in her exhibiting periodic confusion, was adjudicated incompetent, and P, her nephew, was appointed her guardian. P had Conroy placed in the Parkview Nursing Home. She came under the care of Dr. Kazemi, a family practitioner, and Catherine Rittel, a registered nurse, who was the nursing home administrator. Conroy could converse and follow directions, was ambulatory, and was in relatively good physical condition. She became increasingly confused, disoriented, and physically dependent. She was hospitalized on two occasions for dehydration and a urinary tract infection, and later for an elevated temperature and dehydration. A diagnostic evaluation showed that Conroy had necrotic gangrenous ulcers on her left foot. Two orthopedic surgeons recommended that to save her life, her leg should be amputated. P refused to consent to the surgery because he was confident that she would not have wanted it. Conroy did not die from the gangrene. Dr. Kazemi observed that Conroy was not eating adequately. He inserted a nasogastric tube that extended from her nose through her esophagus to her stomach. Medicines and food were then given to her through this tube. On October 18, the tube was removed, and Conroy was fed by hand through her mouth for two weeks. However, she was unable to eat a sufficient amount in this manner, and the tube was reinserted on November 3. When she left the hospital the tube remained. Another attempt at removal was made and failed. Dr. Kazemi, Conroy had such difficulty swallowing that even a person with great time and patience could probably not have coaxed her into absorbing enough fluids and solid food by mouth to sustain herself. Conroy was ase, hypertension in extremely poor condition. But she interacted with her environment in some very limited ways. She could move her head, neck, hands, and arms to a minor extent; she was able to scratch herself, and had pulled at her bandages, tube, and catheter; she moaned occasionally when moved or fed through the tube, or when her bandages were changed; her eyes sometimes followed individuals in the room; her facial expressions were different when she was awake from when she was asleep; and she smiled on occasion when her hair was combed, or when she received a comforting rub. Conroy was not brain-dead, comatose, or in a chronic vegetative state. Her intellectual capacity was very limited, and her mental condition probably would never improve. Dr. Davidoff characterized her as awake, but severely demented, unable to respond to verbal stimuli, and, as far as he could tell, had no higher functioning or consciousness. Dr. Kazemi said that although she was confused and unaware, 'she responds somehow.' The medical testimony was inconclusive as to whether, or to what extent, Ms. Conroy was capable of experiencing pain. Both doctors testified that if the nasogastric tube were removed, Conroy would die of dehydration in about a week. Dr. Davidoff believed that the resulting thirst could be painful but that Ms. Conroy would become unconscious long before she died. Dr. Kazemi concurred that such a death would be painful. Dr. Kazemi stated that he did not think it would be acceptable medical practice to remove the tube and that he was in favor of keeping it in place. Ms. Rittel, the nurse, also thought the tube should not be removed since in her view it was not an extraordinary treatment. Dr. Davidoff would have removed the tube with the family's consent; Conroy seemed to be receiving excellent care, but she did not have long to live, perhaps a few months. In those circumstances, he considered nasogastric feeding an extraordinary, or optional, medical treatment, because it went 'beyond the necessities of life.' Conroy had lived in the same home from her childhood until she was placed in the nursing home, had never married, and had very few friends. She had been very close to her three sisters, all of whom had died. Conroy's only surviving blood relative was P. He had known her for over fifty years, had visited her approximately once a week for four or five years prior to her commitment to the nursing home, and had continued to visit her regularly at the nursing home for some time. There was no question that the nephew had good intentions and had no real conflict of interest due to possible inheritance when he sought permission to remove the tube. Conroy feared and avoided doctors and that, to the best of his knowledge, she had never visited a doctor until she became incompetent in 1979. P also stated that he had refused to consent to the amputation of her gangrenous leg in 1982 and that he now sought removal of the nasogastric tube because, in his opinion, she would have refused the amputation and 'would not have allowed [the nasogastric tube] to be inserted in the first place.' Conroy was a Roman Catholic. The Rev. Joseph Kukura, a Roman Catholic priest and an associate professor of Christian Ethics at the Immaculate Conception Seminary in Mahwah, New Jersey, testified that acceptable church teaching could be found in a document entitled 'Declaration of Euthanasia' published by the Vatican Congregation for the Doctrine of the Faith, dated June 26, 1980. The test that this document espoused required a weighing of the burdens and the benefits to the patient of remaining alive with the aid of extraordinary life-sustaining medical treatment. Father Kukura said that life-sustaining procedures could be withdrawn if they were extraordinary, which he defined to embrace 'all procedures, operations or other interventions which are excessively expensive, burdensome or inconvenient or which offer no hope of benefit to a patient.' Here, he said, the hope of recovery and of returning to cognitive life, even with the nasogastric feeding, was not a reasonable possibility. The means of care were not adding to the value of her life, which was outweighed by the burdens of that life. He therefore considered the use of the nasogastric tube extraordinary. It was his judgment that the removal of the tube would be ethical and moral, even though the ensuing period until her death would be painful. The trial court decided to permit the removal of the tube. It held that the inquiry should be whether life has become impossibly and permanently burdensome to the patient. If so, the court held, that prolonging life becomes pointless and perhaps cruel. It determined that removal of the tube would lead to death by starvation and dehydration within a few days and that the death might be painful. It found that Conroy's intellectual functioning had been permanently reduced to a very primitive level, that her life had become impossibly and permanently burdensome, and that removal of the feeding tube should therefore be permitted. The guardian ad litem appealed. Conroy died with the nasogastric tube intact. The Appellate Division took the case. It held that the right to terminate life-sustaining treatment based on a guardian's judgment was limited to incurable and terminally ill patients who are brain dead, irreversibly comatose, or vegetative, and who would gain no medical benefit from continued treatment. A guardian's decision may never be used to withhold nourishment, as opposed to the treatment or attempted curing of a disease, from an incompetent patient who is not comatose, brain dead, or vegetative, and whose death is not irreversibly imminent. The court concluded that withdrawal of Conroy's nasogastric tube would be tantamount to killing her -- not simply letting her die -- and that such active euthanasia was ethically impermissible. P appealed.

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