Appointment of a Special Medical Guardian and an Individual’s Right to Die

HNWElder Law

By Fredrick P. Niemann, Esq., a NJ Elder Law Attorney

interesting case was just decided in New Jersey on a person’s right to refuse
life supporting medical treatment.  A 42
year old female, was admitted to the hospital with renal failure.  J.M’s condition was so severe that her
treating physicians recommended immediate dialysis to save her life.  J.M. refused to undergo dialysis.  J.M. did not have a health care representative or a health care directive.

hospital filed a court action to appoint a special medical guardian for J.M.,
arguing J.M. was critically ill and lacked the mental capacity to consent to
medical treatment.  The court appointed a
representative to act as counsel for J.M. 
After conducting interviews with various individuals who knew and
treated J.M., the Court appointed representative made a recommendation to the
Court to appoint a special medical guardian so dialysis could begin against
J.M.’s wishes.  As a result, the Court
appointed a second attorney, to represent J.M.’s wishes. 

psychiatrists testified to J.M.’s mental capacity.  Two of the three psychiatrists agreed that
J.M. was incompetent.  The third
psychiatrist concluded that she was making a voluntary choice, had the capacity
to refuse dialysis and understood the consequences of doing so.

also testified at the hearing.  She
testified that she was a devout Christian and she believed that Jesus would
heal her.  She also stated that as a
nursing assistant and home health aid, she had come into contact with elderly
people who were undergoing dialysis.  As
a result, she felt that she did not want to endure what she watched them going
through.  She also expressed financial
concerns involved with the treatment. 
She was a single mother and sole supporter of her seventeen-year old son
and the dialysis would take substantial time away from work.  When asked if she understood the consequences
of refusing dialysis, she told the Court she understood but she did not believe
that her refusal would result in death.

deliberations the Court decided to appoint a special medical guardian.  The Court analyzed whether J.M. was (1) able
to consent to the medical treatment; (2) was a general or natural guardian
available; (3) was immediate medical treatment necessary; and (4) did the
patient have a designated health care representative and/or a health care

the only element in dispute was the issue of J.M.’s capacity to consent.  The Court ruled that a patient has the capacity
to consent to medical treatment if she (1) can reasonably understand her
condition, (2) the effect of the proposed treatment, and (3) the risks of both
undergoing and refusing treatment.  The
Court found it clear and convincing that J.M. did not have the capacity to
refuse dialysis because she refused to acknowledge the inherent risks in doing
so.  The Court also felt that J.M.’s past
medical choices to receive treatment demonstrated an unequivocal desire to
live, which was inconsistent with her decision to refuse dialysis.

a result of this decision, J.M. had dialysis treatment and was reported to be
feeling better. This decision reinforces the importance of a written and
executed advance medical directive.

Have questions, please contact Fredrick P. Niemann, Esq. at (888) 800-7442 or
email him at
for more information.

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