Wednesday, August 21, 2013

PA Court Refuses to Appoint Guardian to Override Patient Wishes











I have defended (here, here, and here) surrogate selection as a mechanism for resolving medical futility disputes.  But there are certainly limits.  Two of the most obvious are these.  First, a surrogate cannot consent to stopping LSMT when the patient herself specifically requested it.  Second, the provider should not even be turning to a surrogate when the patient still has capacity.

Remarkably, St. Luke's Hospital in Allentown, PA seems to have ignored both these limits.  It tried to get the local court to appoint a guardian to consent to stopping LSMT contrary to the patient's own directions that LSMT be continued.  

Not only did the hospital lose, but the court imposed sanctions for even making such an argument.  That order was recently affirmed.  

4 comments:

sibbaldbob said...

In Ontario, Canada - the Heath Care Consent Act considers the scenario where a patient would have a prior expressed wish, but 'would' have changed their mind in light of new circumstances. It is the basis of a Form E application to the Consent and Capacity Board. Given that many people have prior wishes such as "I would not want heroic measures" and other generic statements - this makes perfect sense. The number of cases where someone finds value in a life they previously had articulated they would never want is quite significant. You post makes it seem like this would never be appropriate.

sibbaldbob said...

In Ontario, Canada, the HealthCare Consent Act makes provision for the scenario you seem to believe would never be appropriate. If a surrogate or medical team believes a patient "would" have changed his/her mind in light of possibly unanticipated circumstances, they can apply to the Consent and Capacity Board with a Form E to "depart from previously expressed wishes" of the patient.

sibbaldbob said...

In Ontario, Canada, the HealthCare Consent Act makes provision for the scenario you seem to believe would never be appropriate. If a surrogate or medical team believes a patient "would" have changed his/her mind in light of possibly unanticipated circumstances, they can apply to the Consent and Capacity Board with a Form E to "depart from previously expressed wishes" of the patient.

Guardian Law said...

Great post! Been reading a lot about guardian law. Thanks for the info here!