Matter of Nicole R.

• Decision Date: 21 September 2006
• Docket Number: 8513.
• Citation: 821 N.Y.S.2d 194,34 A.D.3d 99,2006 NY Slip Op 06628
• Parties: In the Matter of the Guardianship of CHANTEL NICOLE R., Appellant. PAMELA R., Respondent; ATTORNEY GENERAL OF THE STATE OF NEW YORK, Intervenor.
• Court: New York Supreme Court — Appellate Division

34 A.D.3d 99

821 N.Y.S.2d 194

2006 NY Slip Op 06628

In the Matter of the Guardianship of CHANTEL NICOLE R., Appellant.

PAMELA R., Respondent;

ATTORNEY GENERAL OF THE STATE OF NEW YORK, Intervenor.

8513.

Appellate Division of the Supreme Court of the State of New York, First Department.

September 21, 2006.

Marvin Bernstein, Mental Hygiene Legal Service, New York City (Karen Gomes Andreasian of counsel), for appellant.

Norman L. Cantor, of the New Jersey Bar, admitted pro hac vice, of counsel, and Gibson, Dunn & Crutcher LLP, New York City (Mark E. Bini and Randy M. Mastro of counsel), and Association for the Help of Retarded Children, New York City (Laurie A. Stride of counsel), for respondent.

Eliot Spitzer, Attorney General, New York City (Oren L. Zeve, Caitlin J. Halligan and Daniel Smirlock of counsel), for intervenor.

Tania F. Seaburg and John F. Von Ahn, Delmar, for NYSARC, Inc., amicus curiae.

OPINION OF THE COURT

TOM, J.P.

This dispute arises out of the appointment, pursuant to SCPA 1750, of petitioner Pamela R. as guardian of the person of her daughter, respondent Chantel R., a 26-year-old mentally retarded person. Mental Hygiene Legal Service, on Chantel's behalf, objects to the appointment to the extent that the guardianship extends to decisions concerning life-sustaining treatment and challenges the constitutionality of the statute under equal protection, due process and vagueness grounds.

Respondent is described as "moderately retarded" but otherwise does not suffer from any particular illness or condition requiring medical treatment.^* The guardianship petition was supported by affidavits from two psychologists who assessed respondent's academic functioning at the first-to-second-grade level and found that she is incapable of making informed or reasonable judgments concerning the withholding or withdrawal of life-sustaining medical care. The affidavits indicate that respondent has an IQ of 52 with cognitive deficits in executive functions and metamemory, which are necessary to abstract reasoning. She is functionally independent in the area of self-care (eating, dressing, bathing, personal hygiene) but is incapable of traveling by herself or performing basic financial transactions, such as making change. Philip Hore, Ph.D. supplemented his psychological assessment, attesting that he had discussed end-of-life issues with respondent and although she had voiced objection to granting her mother authority to withdraw life support, he did not find her capable of even considering the question in the abstract. He stated that her anxiety about death prevented respondent from making a distinction between dying and death that results from the removal of life-sustaining equipment. Alan Felipe, Ph.D. testified that he did not specifically raise end-of-life concerns with respondent but concluded, based on her general cognitive ability, that she lacks the capacity to make a decision regarding her medical treatment.

In a motion for the declaration of her rights under SCPA 1750, respondent asserted that she had expressed objection to granting her mother the power to terminate life-sustaining medical care and requested that the court "determine, after an evidentiary hearing, that she is capacitated to make this specific objection because she understands the meaning of the words with which she has expressed it." She argued that SCPA 1750-b impinges on her fundamental right to life and that the statute grants a guardian the power to make life-and-death decisions without affording a procedure for the proposed ward to object and without specifying a standard of proof for overcoming the objection. She asserted that such substantive and procedural omissions deny her due process by failing to protect her right to life and her prerogative to make medical decisions. Respondent requested a hearing to challenge the sufficiency of the medical certifications, which the court granted.

At the hearing, three experts, including an independent psychologist, opined that Chantel lacked the capacity to make determinations of health care, including end-of-life decisions. Dr. Hore testified that he had supervised respondent's counseling at Lifespire, her group residence, but had only met with her twice. In the course of his discussion with respondent, she expressed the desire to have her mother present to help her if she was connected to life-support equipment. But when he interjected the word "dying" into the conversation, respondent "was not happy at all and said that wouldn't be good, no, I wouldn't want that. I don't want to die." While respondent understood death, he stated, consistent with his affidavit, that she lacked sufficient understanding to object to her mother's role in her medical treatment.

Respondent testified that she wanted her mother to make medical decisions on her behalf. However, respondent indicated that she would want food, water and other medical treatment continued even if her condition was terminal and she might suffer longer before she passed away.

Dr. Felipe, an independent psychologist appointed to conduct an evaluation of respondent, testified that she and her mother have a very close relationship and that respondent had stated her desire to have her mother make decisions for her if she was unable to express her wishes. He stated that he had no reservations in stating that respondent lacks the capacity to make any serious medical decisions.

The court also heard testimony from Dr. Susan Pincus, medical director for the Association for the Help of Retarded Children, who also conducted an evaluation of respondent. The doctor assessed respondent, with a mental age of seven, as being incapable of comprehending the concept of withholding medical treatment. However, respondent was very clear that she wanted her mother to make her medical decisions.

The Surrogate held that the petition is subject to the Surrogate's Court Procedure Act, as amended (L 2002, ch 500, § 2), which expressly requires a finding that a mentally retarded person is incapable of making health care decisions before a guardian may be appointed with the authority to withhold or withdraw life-sustaining medical care (SCPA 1750 [2]; see Matter of M.B., 6 NY3d 437, 441 [2006]). The court found that respondent's answers to questions concerning end-of-life decisions failed to reflect a true appreciation of the consequences of such decisions or even an awareness of the context in which such a determination might be required, concluding that respondent's utterances should not be accorded legal effect. Based on its finding that respondent is incapacitated, the court held that delegation of the authority to make end-of-life decisions to petitioner was appropriate. The court rejected respondent's contention that the statute violated the Equal Protection Clause and that it was unconstitutionally vague. The court declined to decide if the discretion afforded by statute to dispense with a hearing (SCPA 1754) might violate due process because respondent was afforded a hearing in this case. The instant appeal ensued.

This Court holds that any disparity in treatment of a mentally retarded person is justified by legitimate state interests, that respondent has been accorded due process and is not aggrieved on such grounds and that the asserted vagueness of any statutory provision with respect to the withholding or withdrawal of medical treatment is not before us. Therefore, we affirm the ruling in all respects.

As noted in Matter of Storar (52 NY2d 363, 377 [1981], cert denied 454 US 858 [1981]), "The State has a legitimate interest in protecting the lives of its citizens." It may impose treatment upon an individual to combat a health threat and disallow medical procedures that are inherently hazardous to health (id.). However, the State's interest, as manifested by statute and case law, supports the right of a competent adult to decide whether or not to undergo treatment, as reflected in the civil liability imposed for rendering treatment without consent, even though "treatment may be beneficial or even necessary to preserve the patient's life" (id.).

Storar drew a sharp distinction between the ability of a competent individual to leave instructions regarding the rendering or withholding of medical care and the absence of any such capacity in a person who, like Chantel R., was never competent to make decisions about medical care. Any such person "was always totally incapable of understanding or making a reasoned decision about medical treatment. Thus it is unrealistic to attempt to determine whether [s]he would want to continue potentially life prolonging treatment if [s]he were competent" (Storar, 52 NY2d at 380). Invoking the State's interest, as parens patriae, in protecting health and welfare, the Court held that a guardian could not seek to discontinue treatment on behalf of a ward who was never competent. The Court emphasized that the Legislature was the appropriate body to change the law to "enlarge the role of the courts in cases involving discontinuance of life sustaining treatment for incompetents by establishing ... a mandatory procedure of successive approvals by physicians, hospital personnel, relatives and the courts" (id. at 382-383). Storar remained the law for some 20 years.

In 1999, a severely mentally retarded woman, Sheila Pouliot, became terminally ill. It was alleged that she suffered greatly, and needlessly, because the law then required that sh...