ST. PAUL, Minn. (CN) - Courts need not give permission to remove a person from life support if their legal guardians give consent, the divided Minnesota Supreme Court ruled.
The ruling reverses a finding that guardian's control over their ward's medical decisions did not extend to removing life support. The ward at issue in this case, Jeffers Tschumy, had actually already been taken off life support at his attorney's recommendation.
"Even though this appeal may be technically moot," the opinion filed Monday states, "the court has jurisdiction to resolve the appeal because the matter raised is functionally justiciable and presents an important public issue of statewide significance that the court should resolve immediately."
Chief Justice Gildea authored the majority opinion, which inspired two dissents by Justices G. Barry Anderson, Davis Stras and Alan Page. Justice Christopher Dietzen took no part in the consideration or decision of the case.
The court found that all interested parties, including family, the guardian and medical personnel, must first agree that removal from support is in the best interest of the person at issue.
In the subject case, it was determined that Tschumy needed a guardian in 2007 because he could no longer make informed medical decisions for himself. Joseph Vogel became Tschumy's guardian in 2009.
Tschumy had a heart attack and stopped breathing after choking on a sandwich in 2012. He was transported to Abbott Northwestern Hospital where a CT scan showed a brain injury.
"Tschumy's treatment team was in 'unanimous agreement that this unfortunate man [had] suffered irreversible brain damage and [could not] survive,'" the opinion states.
The hospital filed papers with the Hennepin County District Court, asking for specific authorization for Vogel to consent to removing Tschumy from life support, according to the order. Vogel opposed the hospital's motion because, he argued, he already had that authority as Tschumy's guardian.
In response, the court appointed an attorney to represent Tschumy and make a recommendation on what he would want based on an investigation, the opinion states. The attorney agreed that Tschumy should be taken off life support, which he was after the court ordered it.
After Tschumy died and Vogel's guardianship was terminated, the Hennepin County District Court issued a second order.
"The court explained that the medical power granted to guardians under the statute does not give guardians the unrestricted authority to direct the removal of life support," Gildea wrote. "According to the court, the power to direct removal of life support 'is not inherent in any of the enumerated powers normally granted a guardian,' and therefore guardians seeking that power needed specific authorization from the district court."
Though the case is technically moot, the opinion states, there are more than 12,000 wards in Minnesota who are possibly affected by the issue.
One of the arguments presented by Tschumy's attorney states that the decision to remove life support goes beyond the realm of medical decision making and thus requires court approval.
The court found, however, that this too narrowly restricts the authority given guardians, whose actions are always subject to court review but do not require court approval.
Tschumy's attorney further argued that the decision to remove a person from life support is a life-and-death decision, not a medical one, and thus cannot be decided by the guardian.
Despite finding otherwise, the justices in the majority emphasized their respect for the moral implications of removing life support.
"But many 'medical decisions' involve a moral or ethical component, regardless of whether life and death is involved," Gildea wrote. "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.'"
Because families may make the decision to remove life support, the opinion states, guardians must be allowed to do the same.
"Subjecting wards to a different standard, one that often results in extended suffering for the unconscious ward, is unnecessary and potentially cruel when all the parties agree that ending life support and allowing natural death is the appropriate action," the opinion states.
Justice Stras' dissent, which Justice Page joined, argued there is no justiciable controversy at hand and the appeal should have been dismissed outright.
"In the absence of a justiciable controversy, it is the Legislature's job, not ours, to clarify the scope of a guardian's authority in making end-of-life decisions for a ward," Stras wrote.
Justice Anderson dissented separately, saying the statute empowering a guardian over medical decisions does not impart the power to withdraw life-sustaining treatment.
"To state it more bluntly," Anderson wrote, "the plain language of the statute does not authorize the guardian to take action that directly leads to the death of the ward."
The opinion calls the decision to remove a person from life support an "extreme measure," which the Legislature intended to require court approval of when writing the guardianship statutes.
"I acknowledge that the subset of cases subject to the rule announced today is likely small," Anderson wrote, "but the consequences are great and the better course is to rely on judicial supervision and approval for the withdrawal of medical care unless and until the legislature provides a better framework for dealing with these decisions."
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