Charlotte, NC -- The mother of a physically and mentally disabled woman neglected her daughter when she asked doctors to stop giving her food and water, a Mecklenburg, North Carolina County Superior Court clerk ruled Tuesday.

Assistant Clerk Mark Gott replaced Dianne Arnder of Dobson as guardian for her 28-year-old daughter, Tina Cartrette, who remains hospitalized in critical condition.

Don Austin was appointed as the new guardian. He works for The Arc of North Carolina, an advocacy agency for the mentally retarded, and is guardian for 38 others in Mecklenburg County.

"This was not an easy decision," Gott said, after hearing more than seven hours of testimony Monday and Tuesday.

Four doctors from Carolinas Medical Center testified about their disagreement over Arnder's request to remove Cartrette from a respirator and withdraw food and water.

The doctors turned off the respirator Nov. 24 and stopped food and water Nov. 26.

After receiving complaints about Cartrette's care, the Governor's Advocacy Council for People with Disabilities intervened Nov. 29 and persuaded the court clerk to reverse that decision until a hearing could be held. In North Carolina, the clerk of courts has authority in guardianship cases.

In his ruling, Gott partly relied on testimony from Dr. Amie Nielsen, a first-year resident at Carolinas Medical Center, who said Cartrette was not terminally ill. Gott also noted that all four CMC doctors said the fever, urinary tract infection and seizures that caused Cartrette to be hospitalized Nov. 8 had been treated successfully when Arnder decided to discontinue life support.

Gott said Arnder "potentially harmed" her daughter by asking the doctors to remove antibiotics, tube feeding and hydration. He cited testimony from Dr. Bill Mazzella, a third-year resident at Carolinas Medical Center, and Dr. W. Blair Bryan, medical director of the Howell Center in Charlotte, where Cartrette had lived since 1986. The doctors said Cartrette's condition has worsened in the past week and that her decline may be related to the days she spent without food or medicine.

Arnder, who lives in Dobson, about 100 miles north of Charlotte, testified for an hour about her only child, calling her "God's very special child."

She said Cartrette was born healthy but suffered her first seizure at 5 months old. She pulled pictures of her brown-haired, blue- eyed daughter from her wallet. She said her daughter, who has mental retardation and cerebral palsy, "never has been able to sit up, walk or talk or anything" and has lived in residential care facilities since she was 5.

In the past year, Arnder said, her daughter has suffered from recurrent urinary tract infections that cause fevers and seizures and result in repeated hospitalizations.

"Tina has been in and out of the hospital," Arnder said. "I feel like her health is just going to keep deteriorating."

When doctors talked with Arnder about taking her daughter off the respirator and other life support, she said she decided that would be the right thing.

"Tina looked like she was suffering," Arnder said. "My decision was to let my daughter go to heaven and be with God. I did not want to see my daughter suffer anymore. I was just trying to be realistic. I'm trying to do what was best for my daughter."

At the end of Arnder's testimony, Gott asked her if she would make the same decision today. She said she would like to find a skilled nursing facility for her daughter. "I would not withhold anything."

When Gott asked what had changed her mind, she said: "I don't want to end up having a world war like I'm having now. I don't want to fight the world."

Three of Cartrette's doctors - Nielsen and two supervising physicians, Al Hudson and Michael Friedland - testified they believed Arnder was acting in her daughter's best interests.

Nielsen said she was "flabbergasted" when Mazzella voiced ethical reservations about taking Cartrette off the respirator without being able to put her back on if she stopped breathing. Nielsen said the mother then agreed to let them restart the respirator. But when they turned it off, "darn it if she didn't keep breathing," Nielsen said.

Nielsen said she then talked to Arnder about whether she wanted to stop other life support, and she said she did.

"It was her prerogative and within her realm as the patient's surrogate," Nielsen said. "People are free to refuse anything we (doctors) do."

Lawyers for the governor's advocacy council pointed out that N.C. law permits removal of food and water if a patient's condition is terminal and incurable or if the patient is in a persistent vegetative state. No one testified that Cartrette fit that description.

Lance Stell, the hospital's medical ethicist, who was called in to help resolve the doctors' disagreement, said doctors may act outside those conditions, but if they do, they are not immune from prosecution. He said he didn't offer advice on the mother's decision but received reassurance from the doctors that she was a competent guardian.

"In our society, a competent patient can accept or refuse any intervention offered by a doctor for any reason," Stell said. "The disabled have the same basic rights, but they must be exercised by a surrogate. This raises questions about how a surrogate could know what is best for another person. Our society has had a real struggle with the issues presented by cases like this over the last 25 years."

At the request of the mother's lawyer, Woody Connette, Gott closed the hearing to the public Monday. On Tuesday, he reversed that ruling at the request of the media.

At the end of the day, when Gott removed her as guardian, Arnder sat silently at a courtroom table while others gathered their things and left. Her husband, Jerry, sat beside her, head in his hand. Lawyer Connette said he doesn't know what the family's next step will be.