Below is a summary of an important new decision by the Pennsylvania Superior Court regarding whether, and under what circumstances, a guardian has the authority to refuse treatment for an incapacitated person who does not have an end-stage medical condition or is permanently unconscious. In brief, the court held as follows:
1. A court order that appoints a person as a plenary guardian does not authorize that person to refuse life-sustaining treatment for incapacitated persons who do not have end-stage medical conditions or who are not permanently unconscious. In other words, a guardianship order by itself does not authorize the guardian to make such a decision.
2. A guardian must secure a special court order to allow him to refuse life-sustaining treatment for an incapacitated person who does not have an end-stage medical condition or who is not permanently unconscious. The guardian has an "extraordinary burden" to prove by clear and convincing evidence that death would be in the incapacitated person's best interests, i.e., that extending life would be inhumane under the circumstances. The guardian must present specific medical evidence about the incapacitated person's diagnosis, prognosis, pain, etc. and, if at all possible, evidence concerning the incapacitated person's wishes either prior to or during the treatment. The individuals cognitive disability should generally not be considered.
This decision will make it extremely difficult, if not impossible, for a guardian to secure an order that would allow him to refuse life-sustaining treatment when an incapacitated person does not have an end-stage medical condition or is not permanently unconscious.
Full Article and Source:
DRN Offers Summary of New Guardianship/Withholding of Consent to Treatment Case
Disability Rights Network of Pennsylvania (DRN) is a statewide, non-profit corporation designated as the federally-mandated organization to advance and protect the civil rights of adults and children with disabilities.
1. A court order that appoints a person as a plenary guardian does not authorize that person to refuse life-sustaining treatment for incapacitated persons who do not have end-stage medical conditions or who are not permanently unconscious. In other words, a guardianship order by itself does not authorize the guardian to make such a decision.
2. A guardian must secure a special court order to allow him to refuse life-sustaining treatment for an incapacitated person who does not have an end-stage medical condition or who is not permanently unconscious. The guardian has an "extraordinary burden" to prove by clear and convincing evidence that death would be in the incapacitated person's best interests, i.e., that extending life would be inhumane under the circumstances. The guardian must present specific medical evidence about the incapacitated person's diagnosis, prognosis, pain, etc. and, if at all possible, evidence concerning the incapacitated person's wishes either prior to or during the treatment. The individuals cognitive disability should generally not be considered.
This decision will make it extremely difficult, if not impossible, for a guardian to secure an order that would allow him to refuse life-sustaining treatment when an incapacitated person does not have an end-stage medical condition or is not permanently unconscious.
Full Article and Source:
DRN Offers Summary of New Guardianship/Withholding of Consent to Treatment Case
Disability Rights Network of Pennsylvania (DRN) is a statewide, non-profit corporation designated as the federally-mandated organization to advance and protect the civil rights of adults and children with disabilities.
These are decisions that should ONLY be made by family - not strangers!
ReplyDeleteCan you imagine a stranger making medical or life/death decisions for your family pet?
ReplyDeletePeople would be marching / protesting in the streets but oh, it's okay and accepted, if it's for elderly persons, society BLINDLY accepts this because it is via the courts and the courts are preceived to be correct and proper -- that is until it happens to you or someone you love.
Whenever there is a question at the unavoidable end of life time, if the person making the decision is a stranger, then that person must choose life -- every time.
ReplyDeleteThere are some disturbing proposals being considered for the Universal Health Care Plan; ie.,
ReplyDeleteDoctor's being given 'incentives' for diagnosing using their education, skills and expertise vs relying on 'expensive' testing (to prevent malpractice suits). Life Style Care Plans holding the patient responsible for adhering to the Care Plan and denying benefits when non-compliant. Medical Review Boards (similar to what Lawyers have for thier malpractice) to decrease lawsuits. New Legislation giving Doctors the ability (and incentives) to diagnose: 'futile' for terminally ill patients preventing treatments paid under the Universal Health Care Plan. Increasing benefits for Hospice Care. (Missing is the Palliative Care component to Hospice Care benefits)
The Insurance Company has presented a compilation of data suggesting Medical Doctors are reticent to end treatment and discuss end of life issues with their patients increasing medical costs of terminally ill patients. Medical Doctors are educated to treat illness, they are not educated to 'give up' on treatment. Palliative Care increases life spans for terminally ill patients; it is expensive and stressful on patients and their family's. When the patients and their family decides treatment is adversely impacting their quality of life, it is the Medical Doctors who discuss and offer Palliative and Hospice Care. Eliminating the Palliative Care benefits is a disservice to patients as it relieves pain and increases life spans.
These proposed incentives, legal language changes and new laws are in conflict with the Patient's Bill of Rights. Guardianships strip the patient of all rights.
These disturbing proposals, if they become part of the benefit plan will give Medical Doctors incentives to deny treatment, laws to force denial of treatment and lack of benefits to provide treatment. "Stranger" Guardians unlike family members will not Advocate for treatment.
Medicaid has already implemented new rules denying benefits for Foley catheter infections. Foley catherters are a standard practice in Hospice Care: rationale is to prevent skin breakdown as mobility decreases. Comfort care measures; i.e., Hospice Care will promote immobility in otherwise mobile patients as Hospice Care benefits do not pay for medical conditions not contributory to the terminal illness. Ex: If the terminal diagnosis is breast cancer, hospice benefits will not pay for a treatments for a cardiac condition. Without treatment and follow up care by the patient's Cardiologist, it is possible the patient's untreated heart condition could result in death before the terminal illness.
Forcing patients into Hospice Care before 'they' are ready to make that choice could promote death from a chronic condition otherwise managed; denies patients their right to a longer life span; denies patients their religious beiefs: Faith and Hope for a cure and/or miracle.
Hospital's with Hospice Care Units have a two week prognosis for end of life. A 'futile' diagnosis will give a patient in a Hospital two weeks to live.
Hospital's, long term care facilities and in patient hospice care facilities are evaluated using different criteria for patient outcomes. Will laws, insurance benefits and 'incentives' universalize the standard of care for hospice patients? If so, to which type of facility measurement?
Unfortunately, some of these decisions ARE made by fiduciaries after they have bled the estate dry!
ReplyDeleteTheir motto is:
ReplyDeleteBleed the estate, get rid of the problem - next guardianship case.
Bleed the estate, get rid of the problem - next guarudianship case.
And on and on and on and on
Extremely difficult for guardian to make life/death decision in Pa. Sure and the Easter bunny delivers coal to bad guardians in Pa. also. A special court order with EVIDENCE REQUIRED _ knowing Pa. court system, a licensing agency for "legalizing crime" _only for the good ole boys & girls though. Well the new a statute is a good facade anyway_that's what the good ole boys & girls create and feed. Without a facade, the prey might diminish.
ReplyDelete