Court Opinion

ID: 9676681
Source: CourtListenerOpinion
Date Created: 2023-08-24 05:30:13.452577+00
Date Added: 2024-06-11T18:16:50.279963
License: Public Domain

SMART, Judge,
concurring.
A guardian is authorized to consent to medical treatment which is in the best interest of the ward. As a general proposition, a guardian may withhold consent to treatment which is unnecessary or harmful. There are no reported cases in Missouri regarding the legal authority of a guardian to consent to a do-not-resuscitate order. The trial court in this case analyzed Cruzan v. Harmon, 760 S.W.2d 408 (Mo. banc 1988) aff'd 497 U.S. 261, 110 S.Ct. 2841, 111 L.Ed.2d 224 (1990) to determine whether the principles of that case provide guidance for resolution of the issues presented in this case. The court determined that the broad language of Cruzan, its commitment to the protection of patient autonomy, its rejection of “quality of life” considerations,1 and its presumption in favor of continuing life-sustaining treatment in the absence of an expressed contrary choice of the patient, mandated that it deny, authorization for a do-not-resuscitate order in this case.
This is not a case in which Dr. Ryan seeks to withhold nutrition from the patient. Nor is there reason to believe that he seeks permission to terminate the life of the patient. The record suggests that he has conscientiously eared for the patient’s welfare.2 He seeks nothing inconsistent with the principle of Hippocrates: “First, do no harm.” His medical judgment, however, suggests that the patient’s health is so deteriorated that nothing would be accomplished by emergency CPR in the event of a heart attack, and she would be unlikely to survive CPR.
Our respect for life is not undermined by allowing the guardian to consent to the withholding of CPR in this case. Since there is no medical opinion contrary to Dr. Ryan’s, it would be arbitrary to require heroic CPR efforts in the event of a heart attack. The reports which were intended to corroborate Dr. Ryan seemed to be based on considerations which, under Cru-zan, are to be excluded from the analysis. Although the trial court properly had reservations about the wording of these reports, the reports were corroborative and did not contradict or undermine Dr. Ryan’s analysis.
Although I concur in the reversal of the trial court decision, I write separately to emphasize that the authority of court-appointed guardians to consent to DNR orders without court approval is far from unlimited. There must be a sufficient medical basis which is not based on the handicap of the patient, the social utility of the patient’s life, or the value of that life to others.

. Although pain and suffering are sometimes referred to as involving "quality of life,” the concept of "quality of life” which has been held inappropriate for consideration is that which takes into account the "social utility of another’s life, or the value of that life to others.” In re Conroy, 98 N.J. 321, 367, 486 A.2d 1209, 1232-33. Accordingly, the Missouri Supreme Court in Cruzan rejected decision making based upon the "diminished capacity" of an incapacitated person. 760 S.W.2d at 422. Similarly, the Missouri Durable Power of Attorney for Health Care Act forbids discrimination against "handicapped and disabled persons” by any health care surrogate appointed pursuant to the act. Section 404.870 RSMo.Supp.1992.

. For instance, Dr. Ryan has avoided subjecting Ms. Warren to the risks of surgery for her decubitus ulcers because of the likelihood that the surgery would kill her. Ordinarily, surgery would be an appropriate procedure for this condition.