Imagine this all-too-common scenario: A devoted spouse, now in their 80s, becomes the sole caregiver for their partner, who is battling dementia and frailty. The caregiver, overwhelmed but determined to honor what they believe are their loved one's wishes, skips medical checkups or neglects basic needs, thinking it's what the ill spouse would have wanted—"no fuss, no hospitals." Tragically, the ill spouse's condition worsens, leading to emaciation, pneumonia, and death. The surviving spouse, acting out of love and assumption, faces criminal charges, not for malice or intent, but for failing to act. This isn't fiction; it's the essence of a landmark 2024 Kansas Supreme Court case, State of Kansas v. Carol Sue Burris (Kan. No. 123,650, March 15, 2024), where a wife was convicted of reckless second-degree murder and mistreatment of a dependent adult for neglecting her husband's care.
The ruling serves as a sobering reminder for seniors and spouses: without clear advance directives or other legal documents, even well-intentioned inaction can lead to devastating legal consequences. For readers of the Aging in Place Planning and Elder Law Blog, this case highlights the urgency of proactive planning to protect autonomy and prevent such tragedies, especially amid the rising prevalence of elder abuse, which affects up to 5 million seniors annually, according to the National Center on Elder Abuse. Tools like advance directives, supported decision-making (SDM), and powers of attorney can provide the 'cover' needed to navigate caregiving without fear of prosecution. This article unpacks the Kansas case, its emotional and legal ramifications, and actionable steps to shield your marriage and independence.
The Kansas Case: Love, Neglect, and the Legal Duty of Care
Carol Sue Burris, 69 at the time of her 2017 trial, was her husband Michael's sole caregiver as he deteriorated from an array of health issues. Michael, once a robust man, became bedridden, emaciated, and unable to self-care, yet Carol withheld medical intervention. What if she believed it aligned with his preferences? In at least one instance, after a hospitalization, and there were three toward the end of Michael's life, Michael actually demanded to return home, amid allegations of her neglect and refusal to provide him with necessary medical care. The hospital honored his request and returned him to his home, and to conditions that had already, in the eyes of experts, threatened his health and safety.
Neighbors and home health aides raised alarms, but Carol blocked access, leading to an Adult Protective Services investigation. During the third and final hospitalization, Michael's death from pneumonia, compounded by severe malnutrition, prompted charges under Kansas law (K.S.A. 2022 Supp. 21-5417), which criminalizes mistreatment of dependent adults through neglect by those with a "legal or contractual duty" to provide care. The evidence presented at trial was horrific. Read the decision if you must, understanding that the description of Michael's condition is shocking, traumatizing, and heartbreaking.
Carol did not testify, but her interview was introduced to the court. She offered little explanation for her actions and inaction, other than excuses for why she could not do more. A statement that she could not afford to pay third parties because she needed money for her care painted her as unfeeling, despite the fact that consideration of spousal support is baked into federal law, compromising the Community Spousal Resource Allowance (CSRA) for determining Medicaid eligibility. It doesn't appear from the court's recitation of facts, however, that the jury was advised that this consideration of support is lawful, even if not morally defensible. It doesn't appear that Michael's motivations for returning home to such horrific conditions were explored, so one can only speculate whether he, too, was concerned that the cost of his care might harm his wife.
Before proceeding, know that our framing of the facts of this case is not a reflection of an opinion as to Carol's guilt or innocence. It reflects an appreciation that, as horrific as they were, and accurately portrayed by a prosecutor and a family horrified over a premature death with needless suffering, the facts might not accurately depict the intentions of the two people most intimately involved. Another way to consider the case is to assume that you and a spouse made similar decisions or bargains, with similar horrific results, believing that result to be right; would you have foreseen the possibility of criminal conviction? The issue is whether aging in place, without considering the costs or the legal bases for decisions, might create unanticipated legal peril? The answer is a resounding 'yes.'
Carol was tried, convicted, and sentenced to 125 months.
Carol appealed her convictions for reckless second-degree murder and mistreatment, arguing she had no affirmative duty to act, her inaction wasn't criminal, and prosecutors had inflamed the jury with unlawful remarks. The Kansas Supreme Court disagreed in its March 15, 2024, ruling. The court held that Carol's marital relationship, voluntary assumption of caregiving, and role as sole provider created a "clearly defined legal duty" under common law and statute. Failing to summon care or provide necessities wasn't just an oversight; it was a criminal omission, akin to the "termination" of vital support. The prosecutor's comments were deemed fair advocacy, not error. Carol's 10-year sentence was upheld, a stark example of how decisions, unguided and unsupported by documentation, can cross into liability.
This isn't isolated; it's a window into spousal neglect's gray areas. Without directives, caregivers like Carol act on assumptions rather than provable directives. The ruling echoes broader trends: neglect is the most common elder abuse form, often by family, and 1 in 10 seniors faces it, per the National Center on Elder Abuse.
Why This Hits Spouses Hard: The Emotional and Legal Trap
For spouses, caregiving is often a sacred vow, but without "cover" from advance directives, it becomes a minefield. Emotionally, it's devastating: the survivor grapples with guilt, grief, and public scrutiny, as Carol did amid family rifts. Legally, the "duty of care" arises from marriage (common law) and voluntary assumption, turning omission into crime, reckless murder if it foreseeably causes death. No directive means no proof of shared wishes, leaving the caregiver exposed to charges like mistreatment or manslaughter.
In the absence of documents, courts presume a universal duty to summon help, overriding the argument that "he wouldn't have wanted it." This "termination of care" can feel like the fulfillment of a promise, seem to others like betrayal, and be seen by the law as endangerment. For aging couples, it risks the survivor's freedom, assets (via fines or asset forfeiture), and family harmony, potentially triggering guardianship or imprisonment for the accused spouse.
Would the Outcome Be Similar in Missouri and Ohio?
Yes, the result would likely be similar or even harsher in Missouri and Ohio, where spousal duty of care is firmly established in elder abuse statutes, treating neglect as criminal omission by those with a "legal or contractual duty."
In Missouri (RSMo §565.184), abuse includes "intentionally failing to provide care, goods, or services to an elderly person," with penalties up to class A felonies for causing death. Spousal relationships create this duty, and voluntary caregiving strengthens it. Like Kansas, Missouri courts hold that marriage and assumption of care impose affirmative obligations; failure leading to harm (e.g., pneumonia from neglect) could yield reckless homicide charges, with 10+ year sentences.
In Ohio (ORC §5101.60-5101.72), neglect is "failure to provide services necessary to avoid physical harm," criminalized under abuse laws with misdemeanor to felony penalties. Spouses have a common-law duty, and voluntary caregiving creates liability; reckless failure causing death mirrors Kansas's second-degree murder.
In both states, the lack of "cover" from directives would leave the spouse vulnerable, as assumptions don't shield against "duty to act."
Safeguarding Your Marriage: Proactive Steps for Spouses
This case is a call to action: Directives aren't just paperwork, they're your spousal shield. Here's how to protect your partnership:
- Draft Joint Advance Directives: Create a supplemental directive nominating each other as SDM supporters, specifying home care preferences and dementia guidance. Include a "spousal duty clause": "My spouse shall provide or summon care per my wishes, documented here, without liability."
- Use Powers of Attorney and Trusts: Nominate your spouse as primary agent in GDPOAs, with backups. Trusts can fund home care and include anti-guardianship provisions, as in our "SDM-Driven Supplemental Advanced Directive."
- Incorporate SDM for Daily Support: Designate supporters for collaborative caregiving, reducing burnout and providing witness to your wishes, and support for your caregiving spouse and family.
- Plan for Dementia and Neglect: Add clauses like: "In case of incapacity, prioritize home-based care; my spouse's actions per this directive are protected from liability."
- Seek Professional Review: Consult an elder law attorney to ensure enforceability; the costs are $500-2,000, but it saves far more in crises.
For Missouri and Ohio residents, leverage state APS hotlines for guidance, and review our "Handy Link - Reporting Ohio Adult Abuse or Exploitation" for support.
Conclusion: Love Protected by Law
Carol Burris's tragedy, a possible act of devotion twisted into an accusation, reminds us that without directives, even the best intentions lack legal armor. For spouses, it's not about distrust; it's about clarity amid chaos. By documenting wishes, you honor your vows while shielding your partner from unimaginable burdens. While this article has provided a thorough examination of spousal neglect risks and protection strategies, it is by no means comprehensive. The legal landscape evolves rapidly, influenced by state variations and individual circumstances that no single resource can fully capture. Therefore, readers must remain vigilant, consulting reliable sources such as state APS, AARP, and local elder law attorneys, and regularly evaluating their personal situations to identify potential risks. By combining awareness with tools like SDM agreements, POAs, and trusts, seniors and their families can better safeguard independence and thrive while aging in place.
For ongoing support, consult a professional and stay informed. Your security depends on proactive engagement.
