Guardianships on Life-Support: How In re D.L.H. Impacts Surrogate Decision Making in Pennsylvania
By Jonathan L. DeWald.
At 2:47 A.M., Nancy’s breathing stopped. Joe reached his hand to Nancy’s face and pulled her eyelids closed. Uncle George looked back into the room and saw the end had come. He walked down to the nursing station and said, “I think it’s over.”
Although the final moments of Nancy Cruzan’s life were calm, the prior seven years represented a difficult struggle for her husband, parents, and close friends.
An unfortunate car accident left Nancy Cruzan in a persistent vegetative state. Nancy’s parents requested that her feeding tube be removed after it became apparent that her condition would not improve; however, the hospital refused to comply with their request without first receiving court authorization. Ultimately, Nancy Cruzan’s feeding tube was removed but not before the United States Supreme Court issued a landmark decision regarding the authority of surrogate decision makers in matters involving life-sustaining treatment.
Now, assume that the parents of the incapacitated individual, acting as co-guardians, want to refuse medical treatment; yet, instead of being able to reference the statements made by the ward prior to his or her incompetency to support their decision, no such statements exist because the ward has been incompetent since birth. Such facts recently confronted the Pennsylvania Supreme Court in In re D.L.H.
David L. Hockenberry (David) suffered from profound mental retardation since birth and had limited capacities of expression. He resided in the Ebensburg Center, one of six centers operated by Pennsylvania’s Office of Mental Retardation, for over forty-five years. In 2002, the Orphans’ Court appointed his parents, Myrl and Vada Hockenberry, as joint plenary guardians of the person and plenary guardians of the estate for David.
On December 21, 2007, David swallowed a hairpin and grew ill with aspiration pneumonia. The Ebensburg Center transferred David to Memorial Hospital in Johnstown, Pennsylvania, for treatment, and the hospital placed David on a mechanical ventilator. David’s parents attempted to refuse the ventilator treatment, but the hospital asserted that the parents, as plenary guardians of the person, did not have authority to refuse such treatment.
David’s parents filed a petition with the Orphans’ Court to be appointed as David’s health care agents. The Orphans’ Court denied David’s parents’ petition. The Superior Court affirmed the Orphans’ Court’s decision, and the parents appealed to the Pennsylvania Supreme Court. The Pennsylvania Supreme Court upheld the decision using a plain language interpretation of the state’s Health Care Agents and Representatives Act (the Act).