In re Y.P.
| Decision Date | 10 April 2017 |
| Docket Number | 2015 INT 129 |
| Parties | In re: Y.P., An adult. |
| Court | D.C. Superior Court |
This Court was called upon to consider a guardian's request for authority to consent to the withdrawal of life support from her comatose mother in the absence of clear evidence of her mother's wishes and over objections from her mother's siblings. After appointing counsel for the guardian, a visitor and a guardian ad litem; reviewing written reports from the visitor and a primary care physician; and hearing testimony from the physician, guardian, guardian ad litem and several other family members, the Court made an oral ruling granting the guardian's request.1 This written opinion follows.
On June 4, 2014, fifty-one-year-old Y.P. suffered cardiac arrest following a drug overdose. She was transported to the emergency room at United Medical Center and was in cardiac arrest upon arrival. Heroic efforts were made to revive her but she remained unresponsive.
Y.P. sustained massive brain damage due to prolonged oxygen deprivation and was placed on a ventilator. Repeated efforts to wean her from the ventilator were unsuccessful.
While at the hospital, Y.P. developed bacterial pneumonia, which worsened her respiratory condition, and renal failure, which was successfully treated. When reasonably stable, Y.P. was transferred for long-term care to what is now Bridgepoint Hospital. She remained on the ventilator and received artificial nutrition and hydration.
At the time of her hospitalization, Y.P. had not executed an advance directive expressing her wishes for end-of-life care or appointed a durable power of attorney.
Two of Y.P.'s three adult children, as well as four adult siblings and a niece, participated in these proceedings. Though Y.P. was married at the time of her hospitalization, her husband declined to participate.
On March 27, 2015, a social worker at Y.P.'s long-term care facility filed a Petition for a General Proceeding requesting appointment of a general guardian from the Superior Court's Probate Fiduciary Panel to make medical and other decisions for Y.P. A report by Y.P.'s primary physician indicated Y.P. had chronic respiratory failure and profound encephalopathy secondary to anoxic brain injury.
The Court held a hearing on the Petition on April 28, 2015. At the hearing, Y.P.'s daughter indicated she was considering removing her mother from life support. One of Y.P.'s siblings, a sister who resides locally, indicated she would oppose such a decision. Under D.C. Code § 21-2043(c)(2),2 Y.P.'s adult daughter possessed the highest priority to serve as guardian.
All parties were informed that any guardian would need to obtain court authority to consent to the withdrawal of life support.3 Understanding this, Y.P.'s sister voiced no objection to the daughter's appointment. Y.P.'s daughter was appointed general guardian that same day.
Approximately eight months later, on December 4, 2015, the guardian filed a pro se Petition Post Appointment for Approval to Remove Medical Devices seeking authority to consent to the withdrawal of Y.P.'s ventilator and feeding tube.
Given the nuanced legal standard applicable in this case, the Court appointed counsel for the guardian. Upon a hearing on January 11, 2016, the Court also determined a guardian ad litem should be appointed "to determine [Y.P.'s] best interests, insofar as they are relevant to the question of whether [Y.P.] would have consented to the withdrawal of life support," as well as a visitor "to bring the parties up to date on [Y.P.'s] prognosis and, to the extent possible, to investigate [Y.P.'s] position vis-à-vis removing life support[.]" Court's Order of January 12, 2016.
On February 9, 2016, the Court held a second hearing and heard testimony and representations from the guardian; one of Y.P.'s sons; Y.P.'s siblings and a niece; the guardian ad litem; the visitor; and Y.P.'s primary care doctor.
When asked whether Y.P. ever had indicated whether she would have wanted life support withdrawn, the guardian answered, 2/9/2016 Tr. at 28, lines 15-16. The guardian also, however,stated her belief that Y.P. had been on life support Id. at lines 7, 10-11. Finally, the guardian indicated that, if granted the authority she sought, she would not use it immediately; withdrawal of life support "would take time[,] [b]ecause I [would] speak with my family [about it]." Id. at 33, lines 24-25.
Y.P.'s oldest son stated only that he "feel[s] like the permission should be granted . . . just so it's in [his and his siblings'] hands." Id. at 28, lines 23-25. According to the guardian ad litem, the son previously had stated he Id. at 20, line 25 - 21, lines 1-6.
Three of Y.P.'s siblings traveled from their homes in Panama to testify through a Spanish interpreter. One stated that, during his visit to Y.P.'s long-term care facility, Y.P. 2/9/2016 Tr. at 29, lines 14-16.
A second of Y.P.'s siblings stated, Id. at 29, line 24 - 30, line 3.
The third sibling stated, Id. at 30, line 12. Y.P.'s fourth sibling, the sister who resides locally, related a phone conversation with Y.P. two days before Y.P. was hospitalized during which they discussed plans to fly to Panama to renovate their mother's house. "And then [a] few days later, [Y.P.] was in the hospital." Id. at 32, lines 7-8. "When this happened," Y.P.'s sister explained, "I started praying and talking to the Lord." Id. at 32, lines 8-9.
Y.P.'s sister also described dreams that she, her brother and her daughter had had in which Y.P. was out of bed, walking and talking. See id. at 33, lines 3-15. She concluded by telling the Court, Id. at 33, lines 15-17.
According to the guardian ad litem, this sibling "feels extremely strongly that a miracle will happen and that [Y.P.] will be walking, talking and [will] resume her life as it was before." Id. at 24, lines 18-21.
Y.P.'s niece, who also travelled from Panama, stated:
I do believe that if my aunt were meant to die she would have died by now. . . and we are believers. I do believe that God is doing something in my aunt's life. And I do believe that [she] should be given another . . . opportunity, more time. . . She was somebody who loved life. She was Christian. She was a believer even though she stepped away for a while but she believed in God.
Id. at 31, lines 4-14.
The guardian ad litem agreed with the guardian that Y.P. had given no written or oral indication of her wishes regarding end-of-life care.
Based upon her review of Y.P.'s medical chart and discussion with Y.P.'s primary physician, the guardian ad litem stated Y.P.'s brain injury is "profound and severe," 2/9/2016 Tr. at 17, lines 17-18; Y.P. "requires total assistance with all activities of dailylife," id. at 17, lines 20-21; Y.P.'s prognosis is "dismal, with no chance of recovery," id. at 17, line 23; and that "continuing medical treatment in this case is futile[.]" Id. at 18, lines 16-17.
Based upon conversations with Y.P.'s family members, the guardian ad litem also stated that although Y.P. "was religious[,] . . . did go to church . . . [and] did share with her sister some religious beliefs," Y.P. had at some point left her sister's church to join a different church. Id. at 19, lines 8-10. Her reason for doing so remained unclear. Y.P. was a member of the new church at the time she was hospitalized.
Y.P. had no condition requiring ongoing medication and had not previously been hospitalized. Y.P. did, however, suffer from substance abuse addiction. Though family members had tried to convince her to undergo treatment, she never did accept it.
Based largely upon Y.P.'s primary physician's finding that continued treatment would be futile and concluding that, under these circumstances, a reasonable person would not want to remain on life support, the guardian ad litem concluded it would be in Y.P.'s best interest to grant the guardian's petition. Id. at 24, line 19 - 25, line 1.
Upon her review of Y.P.'s medical chart, the visitor, a licensed social worker, reported, "it is evident that [Y.P.'s] care is palliative." Visitor's Report of 2/24/2016 at 2. Although various therapists would exercise and stimulate Y.P.'s muscles, "these efforts [were] intended to retain some muscle tone and [were] in no sense oriented to restoring cognitive functions." Id. Y.P. also experienced sporadic acute care issues, including a bacterial infection that caused "severe, persistent diarrhea," requiring hospitalization to restore her baseline health. Id.
The visitor called to the Court's attention notes from a 2014 care planning meeting at which Y.P.'s sister insisted on keeping Y.P. at "full code," despite doctors' recommendation that Y.P. be designated "Do Not Resuscitate" (DNR). Ultimately, the visitor reported, "the massive damage that [Y.P.'s] brain sustained offers no hope that her brain can recover life sustaining functions." Id.
To continue reading
Request your trial