Legal guardians have the authority to order their wards to be disconnected from life support, according to a state Court of Appeals ruling Monday that said the end-of-life decision shouldn't be dictated by the courts.
"This supports our position that guardians don't need to go back to court to get consent to terminate life support," said Charles Singer, the attorney for the professional guardian appointed for Jeffers Tschumy, the man at the center of the case. "We've been operating under that assumption for 30 years."
Monday's decision overturns a Hennepin County District Court ruling that said end-of-life decisions are too important to be made by a guardian most likely appointed years before to handle matters of daily living.
Minnesota has 12,000-plus wards; the decision could affect those who don't have health care directives in place spelling out their end-of-life decisions. It is the first time such an issue has been addressed in the state courts.
Tschumy, 57, was mentally disabled and living in a group home under the guardianship of Joseph Vogel since 2008. In April 2011, he choked on food and was declared severely brain damaged with little hope for recovery.
Allina Health System filed a motion requesting a judge allow him to be removed from life support either by clarifying that Vogel had the right to make that decision or by issuing the order from the bench.
In May 2011, Hennepin County District Judge Jay Quam authorized the termination of Tschumy's life support but denied Vogel's request for the power to make that decision. Tschumy died.
Five months later, the judge issued a second order saying although state law grants guardians power to consent to medical treatment on behalf of wards, it doesn't give them sole power to terminate life support.
Return to the 1984 ruling
Quam's ruling was the first challenge to the right-to-die issue since the state Supreme Court held in 1984 that District Court judges were permitted to allow removal of support without a secondary hearing. Quam disagreed, saying state law was vague and the District Court needed to ultimately approve the removal of support.
"No one — not even a judge — can look into the future and into the hearts and minds of a guardian to know with confidence that he or she will decide appropriately when, and if, an end-of-life decision needs to be made," Quam wrote.
In Monday's ruling, the Appeals Court reaffirmed the 1984 decision and cited similar rulings on the issue from other jurisdictions.
"Doctors and medical-ethics committees have the most appropriate knowledge and expertise to evaluate the potential for a ward's long-term recovery and quality of life and advising a guardian on end-of-life decisionmaking," the decision said. "Imposing a requirement for additional court involvement in this process would be inconsistent with the Supreme Court's recognition of a private, medically based model of decisionmaking."
Many weigh in
State law empowers guardians to give "any necessary consent to enable, or to withhold consent for, the ward to receive necessary medical or other professional care, treatment or service." Guardians need a judge's permission to approve psychosurgery, electroshock, sterilization or experimental treatment.
If a guardian requests to terminate life support, the state requires a reasonable effort to obtain agreement from the ward and the nearest relative, a physician's written recommendation, a statement that death is imminent or that initiating CPR would be medically futile or would harm the ward, and, if requested, a hospital biomedical ethics report. The decision must go before a judge as a formality, but the final decision still remains in the hands of the guardian.
Vogel was appointed Tschumy's guardian after family members couldn't be reached. Before Tschumy was seriously injured, Vogel asked him about any health directives, but Tschumy refused to talk about it. Vogel made his decision to pursue removing him from life support after talking to his attorney, doctors, other guardians and reading an ethics report that said there would be no further benefit to invasive treatment.
Mike Biglow, attorney appointed to represent Tschumy's interests, argued the case in front of Quam and the Appeals Court. Most guardians receive no training on end-of-life issues, he said. Because some guardians may act irresponsibly, the District Court is in the best position to make impartial and experienced evaluations of termination decisions, he said.
Biglow said he might appeal to the state Supreme Court. Singer doubts the court would review the case, because there wasn't any controversy when Quam made his decision to allow Tschumy to be removed from life support. He didn't fault Quam's ruling because he wanted clarification.
"I think the Appeals Court was swayed by the fact that most other states are moving toward guardians' rights involving termination," Singer said. "If Minnesota reversed itself, it would be an outlier."