Opinion ID: 1119367
Heading Depth: 1
Heading Rank: 8

Heading: the guardian

Text: [4, 5] Under the laws governing guardianships, a guardian is required to assert the rights and best interests of the incompetent person. RCW 11.92.040(3). We hold now that this provision also enables a guardian to use his best judgment and exercise, when appropriate, an incompetent's personal right to refuse life sustaining treatment. See Cantor, 30 Rutgers L. Rev. at 252; Note, 34 Wash. & Lee L. Rev. at 300-02. This holding embodies the views of this court, as stated above: (1) an individual's right of privacy or right to be free from bodily invasion encompasses the right to refuse life sustaining treatment; (2) this right inures equally to the incompetent patient as to the competent one; and (3) the judicial process is a cumbersome forum for exercising such a personal right if an appropriate guardian is available. Although the appointment of a guardian is a judicial process, once a guardian is appointed, the courts need not be involved in the substantive decision to refuse life sustaining treatment. The Quinlan court accepted that the powers of the guardian encompass such a decision, and commentators addressing the nonjudicial decisionmaking process do not question this premise. See Note, 34 Wash. & Lee L. Rev. 285; Cantor, supra. Our guardianship statute provides that a guardian of a person has the power to care for and maintain the incompetent or disabled person, assert his or her rights and best interests, and provide timely, informed consent to necessary medical procedures. (Italics ours.) RCW 11.92.040(3). As refusal of life sustaining treatment is an individual's personal right, we conclude that under this provision the guardian has the power to assert such a right. We note that RCW 11.92.040 lists certain procedures to which the guardian cannot consent without a court order. These exceptions to the general grant of power are: (a) Therapy or other procedure which induces convulsion; (b) Surgery solely for the purpose of psychosurgery; (c) Amputation; (d) Other psychiatric or mental health procedures which are intrusive on the person's body integrity, physical freedom of movement, or the rights set forth in RCW 71.05.370. RCW 11.92.040(3). These exceptions do not seem applicable to the situation we are addressing here. All of the exclusions listed, with the possible exception of amputation, refer to treatments for psychological purposes. In addition, they refer to intrusive treatment, not to the refusal of treatment. Furthermore, because they are express exclusions in a statute, they must be construed narrowly. Jepson v. Department of Labor & Indus., 89 Wn.2d 394, 573 P.2d 10 (1977); In re Monks Club, Inc., 64 Wn.2d 845, 394 P.2d 804 (1964). We conclude, therefore, that the decision to refuse life sustaining treatment is one that falls under the general powers of the guardian and does not routinely require a court order. In giving the guardian the authority to make such a judgment, we are aware of the danger that a guardian might act on the basis of less than worthy motives, i.e., an interest in the incompetent's estate or a desire to alleviate the financial burden of the life sustaining treatment. We believe, however, that safeguards exist within the laws controlling guardianships which protect against such dangers without requiring routine court intervention in the termination decision itself. For example, a guardian of an incompetent is appointed by the superior court and is at all times under the general direction and control of the court. RCW 11.88.010; RCW 11.92.010. The court is said to be the superior guardian of the ward, while the person appointed guardian is deemed to be an officer of the court. Seattle-First Nat'l Bank v. Brommers, 89 Wn.2d 190, 570 P.2d 1035 (1977). Moreover, the guardianship statute provides for notice to various persons connected with the alleged incompetent. RCW 11.88.040. Finally, a guardian ad litem is appointed to protect the interests of the incompetent during the guardian petition proceedings. RCW 11.88.090; see part V(B), infra. These procedures serve to protect against too precipitous a decision or the appointment of one with less than proper motives. Moreover, we do not perceive them as being overly burdensome; a guardianship hearing must be held within 45 days of the filing of the petition (RCW 11.88.030(3)), and the proceedings may be expedited if the appointment is uncontested. RCW 11.88.040. Thus, judicial participation at this juncture affords minimal intrusion into the personal decision regarding treatment, but nevertheless serves to protect against abuse. [4] Once appointed, the guardian's duty is to use his best judgment in deciding whether or not to assert the personal right of the incompetent to refuse life sustaining treatment. The guardian's familiarity with the incompetent's character and personality, prior statements, and general attitude towards medical treatment will assist in making that judgment. The probative value of prior statements by the incompetent regarding refusal of life sustaining treatment has been treated differently by different courts. In Quinlan, the court found that Karen's statements to friends to the effect that she would not want to be kept alive on a life sustaining system were without sufficient probative weight. In re Quinlan, 70 N.J. 10, 41, 355 A.2d 647, cert. denied, 429 U.S. 922, 50 L.Ed.2d 289, 97 S.Ct. 319 (1976). On the other hand, another court considered similar statements, made by the patient while competent, to be probative. In re Eichner, 73 A.D.2d 431, 471-72, 426 N.Y.S.2d 517 (1980), aff'd sub nom. In re Storar, 52 N.Y.2d 363, 420 N.E.2d 64, 438 N.Y.S.2d 266 (1981). [5] These positions may be reconciled by their facts, however. Because of her youth and the casual nature of her conversations, Karen Quinlan's statements were logically regarded as having little probative weight in determining what her choice would have been given her situation. In contrast, Brother Fox, the patient in Eichner, had expressed his opinion during discussions focusing on the Karen Quinlan situation, and he reiterated these views upon learning that he was in need of the operation that ultimately rendered him incompetent. Eichner, at 471. We conclude that prior statements may be probative in determining the wishes of an incompetent patient, with the age and maturity of the patient, the context of the statements, and the connection of the statements to the debilitating event being factors to be weighed by the guardian. There is no evidence that Bertha Colyer explicitly expressed her desire to refuse life sustaining treatment. Nevertheless, her husband and her sisters agreed that Bertha Colyer was a very independent woman, that she disliked going to doctors, and, if able to express her views, that she would have requested the treatment be withdrawn. Given the unanimity of the opinions expressed by Bertha's closest kin, together with the absence of any evidence of any ill motives, we are satisfied that Bertha's guardian was exercising his best judgment as to Bertha's personal choice when he requested the removal of the life support system.