In re Tschumy - Who Guards the Guardians? Courts or Ethics Committees?

This summer, Minnesota joined a handful of other states that have given healthcare ethics committees "gatekeeping" power that was previously exercised by state government officials.  This week, the Minnesota Supreme Court agreed to hear a case challenging that rule.  



In 2012, a Minnesota probate court held that court-appointed guardians do not have the authority to consent to the withholding or withdrawing of life-sustaining treatment unless the court specifically grants them that power.  



The Hennepin County court had appointed a guardian for Jeffers Tschumy in 2008.  In April 2012, Tschumy suffered a cardiac arrest after choking on some food at his group home.  This resulted in irreversible brain injury leaving Tschumy in a persistent vegetative state.  Clinicians at Abbott Northwestern Hospital determined that further medical interventions would not be appropriate.  The HEC similarly determined that Tschumy could not benefit from further intensive treatment.  Tschumy’s guardian agreed.    But despite this consensus, the hospital filed a motion to clarify the guardian’s authority.   



While the court authorized the guardian to consent to the withdrawal of life-sustaining treatment, it cautioned that its specific authorization would always be required.  The court explained that because of the “time gap” between the commencement of a guardianship and the possible need for that guardian to make an end-of-life decision on behalf of the ward, judges could not “practically evaluate potential guardians for the ability to make an end-of-life decision.”   Moreover, guardians “rarely (if ever) receive training on end-of-life issues.”   The court concluded that clinicians must “involve the judicial system - to provide experienced and impartial examination and evaluation of termination decisions.” 



But in 2013, the Minnesota Court of Appeals reversed the district court.  The appellate court determined that judicial oversight is unnecessary when a medical ethics committee has already concurred with the treatment plan of the ward’s physicians.   It explained:  

Although courts are experienced in making reasoned and impartial decisions, 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 Court of Appeals endorsed “a private, medically based model of decisionmaking,”  holding that HECs, not courts, are the best checkpoints on guardian decisions to stop life-sustaining treatment.