This matter involved a 53 year old lifelong incompetent patient who developed aspiration
Pneumonia and required a ventilator in order to breathe. The plenary guardians sought approval to remove the ventilator and asserted that they had the same powers as guardians as “a health agent” in order to make this decision. The Supreme Court decided this matter in the case of In Re: D.L.H. 2 A.3rd 505 (Pa. 2010).

In this case more specifically D.L.H. had suffered from what had been deemed profound mental retardation since birth, and his parents were acting as the plenary guardians/parental life- time guardians. The situation culminated when D.L.H. contracted pneumonia, and the treating physician of D.L.H. determined that a mechanical ventilator was necessary in order to keep him alive. The parents, in their role of plenary guardians, did not believe that it was in their son’s best interest to have that ventilator, and wished to have it not placed and/or removed. Factually, prior to this case working its way through the court system, after being on the ventilator for a number of weeks D.L.H.’s condition improved and it was no longer necessary for him to be on a ventilator.

The Supreme Court in this matter looked at two issues in determining whether the plenary guardians had the right to refuse life preserving medical treatment:

  1. The Health Care Agent’s and Without Representatives Act, 20 Pa. C.S. Section 5451-5471, has a provision which requires that health care providers provide care necessary to preserve the patient’s life when the patient has neither an end stage medical condition or is permanently unconscious.
  2. Under 20 Pa. Section 5462© (1), the sole exception is if the patient is competent and objects or if the health care agent objects pursuant to a health care power of attorney or a living will.

Basically, in order to appoint a health care agent, the patient must have been competent at some point, which he was not in this case. The Supreme Court held that a plenary guardian can never refuse life sustaining treatment for an incompetent person who is not in an end stage medical condition or in a permanent vegetative state, and the plenary guardian cannot refuse this life preserving medical treatment on behalf of a person who lacks or has always lacked the capacity to make such personal health decisions under the circumstances.

Therefore, in a situation such as this when a person is not in an end stage medical condition or in a persistent vegetative state, and the person prior to that time had never expressed any type of directive on life saving treatment, it is not within the purview of the plenary guardian to make the decision to withhold life saving treatment.