Important Decision on Medical Care and People with Disabilities
Important Decision on Medical Care and People with Disabilities
Friends -
On August 17, the Pennsylvania Supreme Court issued an important ruling to assure that individuals with disabilities are not denied necessary life-preserving medical treatment. In re D.L.H. involved a 53-year-old man with an intellectual disability who has resided at Ebensburg Center, a state institution, for most of his life. In 2007, D.L.H. became ill with aspiration pneumonia and was transferred to the hospital. The illness was not life-threatening, but his treating physicians wanted to place him on a ventilator to assist with his breathing during recovery. His parents, who had been appointed to act as his guardians, informed the hospital that they did not want him placed on a ventilator. The hospital refused to follow their directions. D.L.H. recovered several weeks later and returned to Ebensburg.
D.L.H.'s parents/guardians filed a petition in the Orphans' Court, seeking an order that would allow them to make all health care decisions for him as a "health care agent" under Act 2006-169 (Act 169). Act 169 allows individuals who are competent to create health care advance directives and to name health care agents to make decisions in the event they become incompetent to do so, even if they are not at the end of life. The Department of Public Welfare filed a brief opposing the parents'/guardians' petition. The Orphans' Court denied the petition and the Superior Court on appeal generally agreed with that ruling, but left open the possibility that guardians could petition the courts to refuse life-preserving treatment (i.e., treatment needed to save the life of an individual who does not have an end-stage medical condition or is not permanently unconscious) under certain very narrow circumstances.
The Pennsylvania Supreme Court agreed to hear the parents'/guardians' appeal. DRN filed an amicus brief on behalf of DRN, The Arc of Pennsylvania, Achieva, Vision for Equality, Liberty Resources, Inc., the Pennsylvania Developmental Disabilities Council, and Not Dead Yet.
In its August 17 ruling, the Pennsylvania Supreme Court agreed with DPW and Amici that Act 169 explicitly allows only competent individuals or health care agents appointed pursuant to valid health care advance directives (made by a person when s/he was competent to do so) to refuse life-preserving treatment. Act 169 does not permit guardians to make those decisions, even for individuals such as D.L.H. who would have never had capacity to make a health care advance directive and appoint a health care agent. The Court rejected the parents'/guardians' argument that the guardianship statute authorizes plenary guardians to make such decisions.
In sum, the Court unanimously held that "where, as here, life-preserving treatment is at issue for an incompetent person who is not suffering from an end-stage condition or permanent unconsciousness, and that person has no health care agent, the Act [169] mandates that care must be provided." In reaching this holding, the Court appears to have implicitly rejected the Superior Court's suggestion that, under some circumstances, courts might authorize guardians to refuse life-preserving treatment.
A copy of the Supreme Court's decision is available from the DRN web site. Go to http://drnpa.org/File/hockenberry.pdf.