Bob CollinsA divided Minnesota Supreme Court has ruled that a professional guardian can order the removal of life-support for patients without court review.
The court ruled in the case of Jeffers Tschumy, a 53-year-old man with no family who suffered from diabetes, effect of a stroke and partial paralysis from a spinal infection. A professional guardian was appointed in 2009 and when Tschumy suffered irreversible brain damage in April 2012 after choking on food, his guardian directed Abbott Northwestern Hospital to remove life-prolonging treatment.
The hospital’s ethics committee insisted a guardian doesn’t have that kind of unilateral power, and although a district court agreed, the Minnesota Court of Appeals overturned the decision.
Today, Minnesota Supreme Court Chief Justice Lori Gildea agreed that guardians have complete authority to order life-support be withdrawn if all parties agree there’s no hope for recovery.
“When the continued medical treatment of the ward is no longer necessary and no longer in the best interests of the ward because the ward has no reasonable chance to recover, the guardian has not just the ability but likely the duty to decline to consent to continuing medical treatment that harms the ward,” she wrote in her opinion today.
She said any other conclusion “could allow health care providers to subject wards to useless medical procedures simply because the guardian would not have the power to withdraw consent to further treatment.”
We certainly recognize that once medical decision making enters the arena of life and death decisions, different interests are at stake.
Such decision making could implicate moral and religious considerations, and most importantly, the decision, once it is made, is a permanent decision. But many “medical decisions” involve a moral or ethical component, regardless of whether life and death is involved.
The Legislature recognizes this, by requiring that the guardian not consent to medical care on behalf of the ward if such care “violates the known conscientious, religious, or moral belief of the ward.” The fact that important interests are at stake therefore does itself not move the decision making from the guardian to a district court.
But Justice G. Barry Anderson said he’s afraid the ruling — though narrow — will have far-reaching consequences. In a dissent, he wrote that the state law does not give a guardian the right to take action that can lead to the death of a person.
It is to the everlasting credit of Allina here that management recognized the uncertainty in the law and the need to seek court approval for the withdrawal of medical care.
The evidence mustered to support the claim that Tschumy would have wanted life support terminated is extremely weak, which shows the necessity of court involvement before such action is taken.
More importantly, the effect of the rule announced today is to give guardians of the most isolated and vulnerable wards unchecked power to make life-or-death decisions, while simultaneously decreasing the likelihood that any judicial review of this decision will ever occur.
Particularly for cases involving the cognitively disabled, “once the decision is made by the guardian to withdraw medical care, for good or ill, whether for sound motives or base motives, whether that decision is well informed from a medical perspective or otherwise, it will be made in silence and with no check or review of the guardian’s judgment,” Anderson wrote.
Justice David Stras, on the other hand, argued in his dissent that there’s no decision here for the Minnesota Supreme Court to make because Tschumy is dead and his guardian is no longer his guardian. Tschumy died one day after the district court ordered removal of a feeding tube.
The reason is that this appeal has little to do with Jeffers Tschumy. When Tschumy was alive, Abbott Northwestern Hospital sought and obtained a court order to cease providing life-sustaining medical treatment to Tschumy, who died shortly thereafter.
At that point, there was nothing left for the district court, or any other court, to decide in order to resolve the parties’ dispute. It is now more than two years after the cessation of treatment and Tschumy’s death, and the parties to the original dispute have received exactly the relief that they requested.
Yet the parties in this appeal still seek an answer to the question of whether a court order was required to remove life support, a controversial and difficult legal question that is purely academic at this point.
“We are not a junior-varsity legislature,” Stras insisted. “The parties ask us to decide a legal question that is completely disconnected from any case or controversy and to make a pure policy decision about how guardians should act in the future when making life-ending decisions for a ward.”
When the district court ordered removal of life-support equipment, he said, the controversy ended.
Justice Alan Page joined Stras in the dissent but offered no opinion.
