Riddlemoser, In re

• Decision Date: 17 October 1989
• Citation: Riddlemoser, In re, 564 A.2d 812, 317 Md. 496 (Md. 1989)
• Parties: In re Rosa A. RIDDLEMOSER. 17 Sept. Term 1989.
• Court: Maryland Court of Appeals

Page 496

317 Md. 496

564 A.2d 812

In re Rosa A. RIDDLEMOSER.

17 Sept. Term 1989.

Court of Appeals of Maryland.

Oct. 17, 1989.

Barbara Novak (William G. Kolodner, P.A., Bernard Greenberg, all on brief), and Ellen Stoffer, Baltimore, for appellant.

J. Joseph Curran, Jr., Atty. Gen., Ralph S. Tyler, Jack Schwartz, Asst. Attys. Gen., Baltimore, for State of Md., amicus curiae.

M. Rose Gasner and Fenella Rouse, Richard Wasserman, Sinnreich & Wasserman, New York City, and Robert J. Ryan and Moore, Carney, Ryan & Lattanzi, Baltimore, for Soc. for the Right to Die, Inc., amicus curiae.

Varda N. Fink, Carolyn Jacobs, Baltimore, for Johns Hopkins Health System Corp., Johns Hopkins Hosp., Francis Scott Key Medical Center, Homewood Hosp. Center, John R. Metz and Piper & Marbury of Baltimore, for Bon Secours Extended Care Facility, Bon Secours Hosp Carroll County Gen. Hosp., Caroline Nursing Home, Children's Hosp. and Center for Reconstructive Surgery, Peninsula Gen. Hosp. Medical Center, St. Mary's Hosp., Shady Grove Adventist Hosp., Shady Grove Nursing Center, Sinai Hosp. of Baltimore, University of Maryland Medical System and Washington Adventist Hosp., amici curiae.

Argued before MURPHY, C.J., and ELDRIDGE, COLE, RODOWSKY, McAULIFFE, ADKINS, and BLACKWELL, JJ.

MURPHY, Chief Judge.

We granted certiorari in this case upon a certification of issues of law from the Court of Special Appeals, pursuant to Maryland Rule 8-304. A threshold procedural issue is whether, if the appeal is now moot, we should nevertheless address the substantive issue in the case because of the urgency of establishing a rule of future conduct. The substantive issue presented is whether circuit courts possess authority to authorize a guardian to withhold life-sustaining medical treatment from a "disabled person" in the event of cardiac arrest.

I.

Maryland Code (1974, 1988 Cum.Supp.), Title 13 of the Estates and Trusts Article is entitled "Protection of Minors and Disabled Persons." ¹ Section 13-105(b) provides that circuit courts "have exclusive jurisdiction over protective proceedings for disabled persons." Section 13-101(d), together with § 13-201(c)(1), defines a "disabled person" in part as one, other than a minor, who has been judged "by a court to be unable to manage his property ... and affairs effectively because of physical or mental disability, senility, or other mental weakness, disease, habitual drunkenness, addiction to drugs, imprisonment, compulsory hospitalization confinement, detention by a foreign power, or disappearance." See also Maryland Rule R70(b).

Sections 13-704 through 13-710 are codified within Subtitle 7 (Guardian of the Person) of Title 13. Part II thereof, entitled "Disabled Persons," provides in § 13-704 that the court "may superintend and direct the care of a disabled person, appoint a guardian of the person, and pass orders and decrees respecting the person as seems proper, including an order directing the disabled person to be sent to a hospital." Section 13-705 authorizes the court to appoint a guardian of a disabled person when it finds

"from clear and convincing evidence that a person lacks sufficient understanding or capacity to make or communicate responsible decisions concerning his person, including provisions for health care, food, clothing, or shelter, because of any mental disability, senility, other mental weakness, disease, habitual drunkenness, or addiction to drugs, and that no less restrictive form of intervention is available which is consistent with the person's welfare and safety."

Section 13-708(a) provides that the court "may grant to a guardian of a person only those powers necessary to provide for the demonstrated need of the disabled person." Section 13-708(b) provides that, subject to the limitations of subsection (a), "the rights, duties, and powers which the court may order include ... (8) The power to give necessary consent or approval for medical or other professional care, counsel, treatment, or service, except that the court must authorize any medical procedure that involves a substantial risk to life."

II.

On August 19, 1985, the Circuit Court for Baltimore City (Kaplan, J.) found Rosa A. Riddlemoser to be a "disabled person" under the pertinent provisions of the Estates and Trusts Article. Judge Kaplan subsequently appointed William J. Kolodner as guardian of Riddlemoser's property and co-guardian of her person, together with the Executive Director of the Baltimore City Commission on Aging and Retirement Education. The guardians were thereby authorized "to consent to medical or other professional care, counsel, treatment, or service ... except that this Court must authorize any major surgery or any other medical procedure that involves a substantial risk to the life of the disabled."

On November 1, 1988, Riddlemoser was admitted in a comatose condition to Union Memorial Hospital in Baltimore. She had suffered a stroke which caused her to lose control of her bodily functions; she had to receive nutrients from a gastric feeding tube. Prior to her admission to the hospital, Riddlemoser had been living in her apartment under around-the-clock supervised nursing care. On November 2, 1988, Dr. Edwin Berstock, Mrs. Riddlemoser's treating physician, recommended that, because of her extremely bad prognosis, no "aggressive heroic measures" be undertaken in the event she were to suffer cardiac arrest.

Counsel was appointed for Riddlemoser on November 4, 1988. That same day, the guardians petitioned the Circuit Court for Baltimore City for an order that cardiopulmonary resuscitation and/or other life prolonging medical treatments be withheld should cardiac arrest take place.

A hearing was held before Judge Thomas Ward on November 9, 1988 to determine whether a "Do Not Resuscitate" order should be issued in the event Riddlemoser were to suffer cardiac arrest. Dr. Berstock testified that Riddlemoser was suffering from cerebrovascular thrombosis (a blood clot within a vein in the brain) which was caused by two strokes, one in August 1985 which rendered her disabled, and one in November 1988. A Computerized Axial Tomography (CAT) scan performed on Riddlemoser showed that she had suffered "massive intra-cerebral hemorrhaging." The doctor also testified that as a result of the strokes, her brain had been "effectively destroyed" and that she would not regain consciousness. A neurologist and neurosurgeon had also examined Riddlemoser and they concurred with Dr. Berstock's opinion. Additionally, Dr. Berstock testified that in his opinion attempted cardiopulmonary resuscitation would be "inhuman." ² At the conclusion of the hearing, Judge Ward declined to issue the order. He stated that whether the relief sought by the guardians should be granted was "not properly before this court," thereby indicating his belief that he lacked authority to issue the order. ³

Mrs. Riddlemoser's counsel and her guardians appealed to the Court of Special Appeals. Prior to oral argument in that court, Riddlemoser died when she suffered cardiac arrest and could not be revived. As earlier observed, the Court of Special Appeals, notwithstanding Riddlemoser's death, certified the important issue of law for our consideration.

III.

Counsel for Riddlemoser, her guardians and a number of amici curiae (the State of Maryland, the Society for the Right to Die, Inc., and a substantial group of health care providers), urge us to decide the substantive legal question of whether the circuit court, under § 13-708(b)(8), had authority to authorize the guardians of Riddlemoser's person to withhold life-sustaining medical treatment. While recognizing that the appeal is moot in view of Riddlemoser's death, they correctly point out that we possess constitutional authority to decide a moot case, citing Mercy Hosp. v. Jackson, 306 Md. 556, 562, 510 A.2d 562 (1986). See also Robinson v. Lee, 317 Md. 371, 564 A.2d 395 (1989) and State v. Peterson, 315 Md. 73, 82-85, 553 A.2d 672 (1989). They urge that we exercise this authority because an expression of our views is of vital importance to the public interest.

A question is moot if, at the time it is before the court, there is no longer any existing controversy between the parties. See Mercy Hosp., supra, 306 Md. at 562, 510 A.2d 562; Attorney Gen. v. A.A. School Bus, 286 Md. 324, 327, 407 A.2d 749 (1979); State v. Ficker, 266 Md. 500, 506-07, 295 A.2d 231 (1972); Lloyd v. Board of Supervisors of Elections, 206 Md. 36, 39, 111 A.2d 379 (1954). We have said time and again that courts do not sit to give opinions on abstract propositions or moot questions; appeals which present nothing else for decision are dismissed as a matter of course. Ficker, supra, 266 Md. at 506-07, 295 A.2d 231; Potts v. Governor of Maryland, 255 Md. 445, 449, 258 A.2d 180 (1969); Washburne v. Hoffman, 242 Md. 519, 525, 219 A.2d 826 (1966). An exception to this rule exists "only in rare instances which demonstrate the most compelling of circumstances." Reyes v. Prince George's County, 281 Md. 279, 297, 380 A.2d 12 (1977). The "rare instances" when the Court will express its views in moot controversies were well articulated in Lloyd, supra, 206 Md. at 43, 111 A.2d 379, as follows:

"[O]nly where the urgency of establishing a rule of future conduct in matters of important public concern is imperative and manifest, will there be justified a departure from the general rule and practice of not deciding academic questions.... [I]f the public interest clearly will be hurt if the question is not immediately decided, if the matter involved is likely to recur frequently, and its recurrence will involve a relationship between government and its citizens, or a duty of government, and upon any recurrence, the same difficulty which prevented the appeal at hand from being heard in time is likely to prevent a decision then the Court may find justification for deciding the issues raised by a question which has...