In Re the GUARDIANSHIP OF Jeffers J. TSCHUMY, Ward
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Full Opinion
OPINION
The question presented in this case is whether court approval is required before a guardian who has the power to consent to necessary medical treatment for a ward under Minn.Stat. § 524.5-313(c)(4)(i) (2012), may consent to remove the ward from life-sustaining treatment when all the interested parties agree that such removal is in the ward’s best interests. The district court held that a guardian who possesses the medical-consent power under Minn.Stat. § 524.5 — B13(c)(4)(i), cannot consent to the removal of a ward’s life support without prior court approval. The court of appeals reversed, holding that unless otherwise limited by court order, a guardian given the statutory medical-consent power has the authority to consent to the removal of life-sustaining treatment without a separate order from the district court. Because we conclude that the guardian did not need further court approval, we affirm.
On September 24, 2007, a social worker at appellant Jeffers Tschumy’s nursing facility filed a petition asking the Hennepin County District Court to appoint a guardian for Tschumy. The social worker said 53-year-old Tschumy was “an incapacitated person” who “lack[ed] sufficient understanding or capacity to make or communicate responsible decisions concerning his person.” According to the social worker, Tschumy was “facing multiple medical issues” and was “unable to make informed medical decisions.”
After a hearing, the district court appointed Tschumy’s then conservator to be his guardian. The court found “clear and convincing evidence” that Tschumy was “an incapacitated person” who needed a guardian. See Minn.Stat. § 524.5-310(a)(1) (2012) (“The court may appoint a ... guardian ... only if it finds by clear and convincing evidence that ... the respondent is an incapacitated person.”). The court made several findings of fact regarding Tschumy’s needs at the time, many of which referred to his inability to make medical decisions for himself. The court said Tschumy needed assistance providing for his “health care, housing, food, transportation, and finances,” and acknowledged that Tschumy did not appropriately manage his diabetes. The court also found that Tschumy was “incapable” of exercising certain “rights and powers,” including the ability to consent to necessary medical care. In the letters of guardianship, the court gave the guardian the authority to, among other things, “[g]ive any necessary consent to enable, or to withhold consent for, the Ward to receive necessary medical or other professional care, counsel, treatment or service.”
On October 6, 2009, the court replaced the first guardian with respondent Joseph Vogel. The court gave Vogel the same powers as the prior guardian and also named Vogel to be Tschumy’s conservator. The successor letters of general guardianship said Vogel had the power and authority to “[g]ive any necessary consent to enable, or to withhold consent for, the Ward to receive necessary medical or other professional care, counsel, treatment or service.”
On April 28, 2012, Allina Health System, d/b/a Abbott Northwestern Hospital, filed a motion asking the Hennepin County District Court to amend the successor letters of general guardianship to “specifically authorize the guardian to request removal of life support systems.” The district court held a hearing the next day. Vogel opposed the motion to amend the successor letters, arguing that he already had the authority to approve the removal of life support. The court appointed attorney Michael Biglow to represent Tschumy, investigate what Tschumy would want, and make a recommendation to the court.
At a separate hearing the next week, Vogel testified that he had been a professional guardian and conservator for 24 years. Vogel said that prior to the April 2012 incident, he had tried to talk to Tschumy about what he would want to do in end-of-life situations, but that Tschumy “did not wish to talk about advanced directives.” Vogel was not surprised by Tschumy’s unwillingness because of Tschu-my’s “severe and chronic mental illness, and his attitudes towards the medical profession.” Nonetheless, Vogel testified that he believed he had the authority to direct the hospital to remove Tschumy’s life support. He said the court authorized him to “provide medical decision making for Mr. Tschumy when [he] was unable to do so and that medical decision making would be not only the provision of different medical services but the ending of those services ... [if] appropriate.” Vogel said he visited Tschumy, talked to doctors and nurses, and relied on his own observations of Tschumy over the course of the guardianship to decide that the hospital should remove Tschumy’s life support.
Tschumy’s attorney, Michael Biglow, also testified. Based on his investigation, Biglow said he believed Tschumy “would not want to be inside, confined to a hospital bed, having medical decisions made for him, by medical personnel and therefore, he would most likely opt not to have these life support services in place.” Tschumy, he said, “would prefer to be ... allowed to die naturally.” Biglow also noted in his report that the hospital’s ethics committee recommended that life support be removed because the “burdens and risks” of continued treatment “heavily outweigh any possible benefits.”
In an order filed May 11, 2012 (“May order”), the district court authorized the guardian and the hospital to remove Tschumy’s life support systems. The
On October 18, 2012, the district court filed a second order (“October Order”), explaining why it concluded guardians do not have the power under Minn.Stat. § 524.5-313(e)(4)(i), to direct the Removal of life support without prior court approval. The court explained that the medical power granted to guardians under the statute does not give guardians the unrestricted authority to direct the removal of life support. According to the court, the power to direct removal of life support “is not inherent in any of the enumerated powers normally granted a guardian,” and therefore guardians seeking that power needed specific authorization from the district court.
Vogel appealed the district court’s October order.
With respect to the merits of the case, the court of appeals reversed the district court. In re Guardianship of Tschumy, 834 N.W.2d 764, 775 (Minn.App.2013). The court of appeals held that absent a limitation in the guardianship order, “the medical-consent power granted to a guardian” under Minn.Stat. § 524.5-313(c)(4) includes the power to authorize disconnection of a permanently unconscious ward’s life-support systems “without further authorization from the district court.” Id. at 775. We granted the petition for review that Biglow, Tschumy’s court-appointed attorney, filed.
I.
We turn first to the question of whether we have jurisdiction to decide this case. The parties do not contend that we lack jurisdiction. But the existence of a
A.
There are several interrelated, potential jurisdictional problems in this case. Tschumy has died, and no ruling we make will affect him. Vogel has been discharged as Tschumy’s guardian, and similarly, no ruling we make will affect the scope of his guardianship over Tschumy. As a result, there are questions about the parties’ continuing interest in this case, as well as questions about Vogel’s standing to appeal the district court’s October order and Tschumy’s standing to appeal the court of appeals decision. See Twin Cities Metro. Pub. Transit Area v. Hotter, 311 Minn. 423, 425 n. 3, 249 N.W.2d 458, 460 n. 3 (1977) (“That a party must be aggrieved in order to appeal remains fundamental to ... Rule 103.03, Minnesota Rules of Civil Appellate Procedure.”). When the case began, both parties before us had a clear interest in the case. But the parties may have subsequently lost that interest. In this context, the jurisdictional question presented is fundamentally one of mootness. As the Supreme Court has recognized, mootness is “the doctrine of standing set in a time frame: the requisite personal interest that must exist at the commencement of the litigation (standing) must continue throughout its existence (mootness).” Friends of the Earth, Inc. v. Laidlaw Envtl. Servs., Inc., 528 U.S. 167, 189, 120 S.Ct. 693, 145 L.Ed.2d 610 (2000) (citation omitted) (internal quotation marks omitted).
We have not previously considered whether we should dismiss an appeal that arises in the unusual context presented itere.
Our precedent similarly permits us to exercise our discretion to consider a case that might be technically moot as an exception to our mootness doctrine. We have said that we have authority to decide cases that are technically moot when those cases are functionally justiciable and present important questions of statewide significance. E.g., State v. Rud, 359 N.W.2d 578, 576 (Minn.1984). Our mootness doctrine therefore is flexible and discretionary; it is not a mechanical rule that we invoke automatically. Kahn v. Griffin, 701 N.W.2d 815, 821 (Minn.2005).
For example, in State v. Rud, the question presented was whether a defendant, accused of criminal sexual conduct, could compel the alleged child victims and other potential child witnesses to testify at the defendant’s omnibus hearing. 359 N.W.2d at 575. The district court concluded that the defendant did not have the right to subpoena these witnesses, but the court of appeals reversed. Id. After we granted the State’s petition for review, the State dismissed the charges against the defendant. Id. at 576. Even though there was no longer a live controversy between the parties, we declined to dismiss the appeal and instead resolved the question presented in the case. Id. We did so because the case was “functionally justiciable,” and “the issues presented are important public issues of statewide significance that should be decided immediately.” Id.
With respect to the first requirement, we said that “[a] case is functionally justi-ciable if the record contains the raw material (including effective presentation of both sides of the issues raised) traditionally associated with effective judicial decision-making.” Id. We held that the requirement was met, noting the quality of both parties’ arguments and the fact that the parties “agree[d] that the appeal should not be dismissed as moot.” Id. In discussing the second requirement, we expressed concern about the “adverse impact” that could occur in pending criminal cases if we declined to resolve the issues in Rud but were to wait for those issues to be presented in a future case. Id. Based on that concern and the importance of the issues presented, we exercised our discretion to decide those issues in Rud. Id.
We reached the same conclusion in Jasper v. Commissioner of Public Safety, 642 N.W.2d 435 (Minn.2002). In that case, a driver whose license was revoked challenged the revocation, contending that the commissioner’s rule approving use of the equipment at issue was not valid. Id. at 436. The district court rejected the challenge and the court of appeals affirmed. Id. After we granted the driver’s petition for review, the commissioner promulgated
We reached the opposite conclusion in Limmer v. Swanson, 806 N.W.2d 838, 839 (Minn.2011). Even though the two requirements of functional justiciability and an important public issue of statewide significance existed, we declined to exercise our jurisdiction and dismissed the case as moot. Id. The question presented in Lim-mer was whether the judiciary could authorize certain expenditures by the executive branch in the absence of legislative appropriations. Id. at 838. While the case was pending, the Legislature passed and the Governor signed into law appropriations bills for all executive branch agencies covering the time period in question in the case. Id. at 838-39. We agreed that we had the authority to decide the case. Id. at 839. But we declined to exercise that authority because the case presented “fundamental constitutional questions about the relative powers of the three branches of our government” and because of our reluctance to resolve such questions “‘unless it is necessary to do so.’” Id. (quoting State v. N. Star Research Dev. Inst., 294 Minn. 56, 81, 200 N.W.2d 410, 425 (1972)). Rather than exercising our discretion to decide the constitutional question, we deferred to the ability of the executive and legislative branches to “put mechanisms in place that would ensure
B.
With these cases in mind, we turn to the jurisdictional question presented here. Our analysis in the cases discussed above where we interpreted our mootness doctrine leads us to conclude that we should exercise our discretion to decide the issue raised in this case. The question of whether a guardian needs prior court approval to consent to the removal of life-sustaining treatment is functionally justiciable. The question was ably briefed and argued by the parties and the record contains the factual information necessary for a decision. In addition, there was thoughtful and informative amicus support for the position that each party advocated. We likely would not have any more information at our disposal if we were to wait for another case to present the same issue. See Rud, 359 N.W.2d at 576 (“[Rjather than waiting for another case presenting these same issues, which are now properly before us and ready for decision, we decide them now.”).
In addition, this case presents an important public issue of statewide significance. Guardianship law exists as a function of the State’s parens patriae
The impact of uncertainty on such an important question also counsels in favor of exercising our discretion to resolve this issue in this case. The district court’s May order notes “that there are thousands of guardians in Minnesota holding the same power that Mr. Vogel has.” And in her amicus brief, the Attorney General represents that there are over 12,000 wards under State supervision in Minnesota. A decision from our court will help clarify for the guardians and their wards the scope of the guardians’ authority to make one of life’s most fundamental decisions.
We acknowledge the possibility that the issue presented here could arise in a future case. After all, the essence of the question presented in this case has been before our court previously. See In re Con-servatorship of Torres, 357 N.W.2d 332 (Minn.1984). In that case, the district court authorized a conservator to remove life-sustaining treatment, but the court stayed the operation of its order pending appeal. Id. at 336. We did not issue our opinion until 7 months after the district court stayed the operation of its order. The record in this case convinces us that the procedure used in Torres is not the path that best serves the welfare of the person under the State’s protection and supervision. Id. at 338 (“Under Minnesota law, a probate court must act in the ‘best
Indeed, the procedure used in Torres, which required the wdrd to be kept alive, would be unjust and unnecessarily cruel had it been forced upon Tschumy. This is so because even during the brief period that the district court deliberated about whether to allow the hospital tq remove Tschumy from life support systems, the evidence was that Tschumy suffered continual seizures that could not be cdntrolled unless his physicians forced him, through medication, further into unconsciousness: into “deep sedation.” And according to the physicians, continuing medical intervention was not only “futile,” but was likely “harmful” to Tschumy. The sound exercise of judicial discretion does not permit us to ignore the potential harm that the most vulnerable would face were we to dismiss this case in the name of preserving for appellate review the purity of an active controversy in a future case.
Because this case is functionally justicia-ble and the issue presented is one of public importance and statewide significance that we should decide now, our precedent provides us with the authority to decide this case even though it is technically moot. See, e.g., Rud, 359 N.W.2d at 576. The reasons we discuss above that favor the exercise of this discretion are compelling. And, unlike in Limmer, there are no countervailing constitutional and prudential considerations warranting a decision not to exercise jurisdiction in this case. See 806 N.W.2d at 839. The prudential considerations weigh heavily in favor of exercising jurisdiction in the unusual context presented here, given that it is our obligation to afford paramount consideration to the “welfare” of the ward. Lawrence, 86 Minn, at 312, 90 N.W. at 770. We therefore hold that we have jurisdiction and turn to the merits of the case.
We are asked to decide whether a guardian appointed under Minn.Stat. § 524.5-313(c)(4)(i) has the authority to make a decision to discontinue a ward’s life-sustaining treatment without first seeking a court order. This is a question of statutory interpretation that we review de novo. In re Welfare of J.B., 782 N.W.2d 535, 539 (Minn.2010).
The statute generally authorizes the district court to appoint a guardian for an “incapacitated person” in need of assistance with decision making. Minn.Stat. § 524.5-313(c). Guardians so appointed are “subject to the control and direction of the court at all times and in all things.” Minn.Stat. § 524.5-313(a) (2012). And the statute authorizes the court to “grant to a guardian only those powers necessary to provide for the demonstrated needs of the ward.” Minn.Stat. § 524.5-313(b) (2012).
Paragraph (c) in the statute is the focus of the dispute here. This provision provides:
The duties and powers of a guardian or those which the court may grant to a guardian include, but are not limited to:
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(4)(i) the power to give any necessary consent to enable the ward to receive necessary medical or other professional care, counsel, treatment, or service, except that no guardian may give consent for psychosurgery, electroshock, sterilization, or experimental treatment of any kind unless the procedure is first approved by order of the court as provided in this clause. The guardian shall not consent to any medical care for the ward which violates the known conscientious, religious, or moral belief of the ward[.]
Minn.Stat. § 524.5-313(c).
Section 524.5-313(c)(4)(i) gives guardians “the power to give any necessary consent to enable the ward to receive necessary medical or other professional care, counsel, treatment, or service.” The essence of the parties’ dispute is whether the medical-consent power includes the authority to direct that a ward be removed from life support systems. Vogel argues that it does.
For his part, Tschumy, through his attorney, contends that the statute does not give guardians the power to authorize the removal of life support systems. He offers several arguments in support of that contention. Tschumy argues that because decisions regarding life support are so significant, the district court must specifically authorize them. Tschumy next argues that because life-sustaining treatment was not necessary when the district court appointed his guardian, the guardian therefore does not have the power to withdraw such treatment. And Tschumy contends that because the decision to remove a ward from life support systems includes more than simply a medical decision, the medical-consent power in the statute does not cover decisions to discontinue life support. Finally, Tschumy argues that his right to due process compels the conclusion that his guardian did not have the authority to remove him from life support. We consider each of Tschumy’s arguments in turn.
A.
We turn first to Tschumy’s argument that because the authority to make deci
It is true, as Tschumy argues, that the statute does not directly address decision making regarding the provision of life-sustaining treatment through use of the words “withdraw,” “discontinue” or “terminate.” But Tschumy does not contend that the treatment at issue is not medical treatment, and he apparently agrees that Vogel had the authority, under Minn.Stat. § 524.5 — 313(c)(4)(i), to consent to Tschumy being placed on the life support systems. Tschumy argues, in essence, that the authority to discontinue such treatment, because of the consequences of such a decision, leads to the conclusion that the guardian lacks the authority to make the decision to discontinue the treatment. We disagree.
To adopt Tschumy’s reading, we would have to conclude that the power to “consent” to necessary medical treatment does not include the power to withdraw that consent. The plain and ordinary meaning of “consent” is “[a]greement, approval, or permission as to some act or purpose, esp. given voluntarily by a competent person; legally effective assent.” Black’s Law Dictionary 368 (10th ed.2014). The concept of “consent” is premised on the idea of voluntary decision making, which necessarily includes the ability to choose to say “no.” Indeed, when the continued medical treatment of the ward is no longer necessary and no longer in the best interests of the ward because the ward has no reasonable chance to recover, the guardian has not just the ability but likely the duty to decline to consent to continuing medical treatment that harms the ward. See In re Guardianship of Overpeck, 211 Minn. 576, 583, 2 N.W.2d 140, 144 (1942) (“The best interests of the ward should be the decisive factor in making any choice on his behalf.”).
A contrary reading of the statute eliminates this duty and it would lead to a fragmentation of the power of consent that could allow health care providers to subject wards to useless medical procedures simply because the guardian would not have the power to withdraw consent to further treatment. Such a result would, in effect, “reduce the guardian’s control over medical treatment to little more than a mechanistic rubberstamp for the wishes of the medical treatment team.” Rasmussen by Mitchell v. Fleming, 154 Ariz. 207, 741 P.2d 674, 688 (1987); see also In re Law-rance, 579 N.E.2d 32, 39 (Ind.1991) (“This right to consent to the patient’s course of treatment necessarily includes the right to refuse a course of treatment.”); In re Rid-dlemoser, 317 Md. 496, 564 A.2d 812, 816 n. 4 (1989) (holding that by necessary implication, the power to give consent for medical treatment “includes the power to withhold or withdraw consent”). In other words, reading “consent” as not including the authority to withdraw consent to life-sustaining treatment is not a reasonable interpretation of section 524.5-313(e)(4)(i). See Savela v. City of Duluth, 806 N.W.2d 793, 797 n. 1 (Minn.2011) (rejecting alternative reading of statute as unreasonable and concluding statute was not ambiguous).
Tschumy’s reading of section 524.5-313(c)(4)(i) is also inconsistent with
In addition, many decisions about medical treatment, such as consent to certain surgeries or treatments with grave side effects, could be characterized as involving life and death determinations. If we were to adopt Tschumy’s reading of the statute, all of these types of medical decisions would require separate court approval unless each was specified in the guardian’s appointment order. There is no basis in the statutory language for such a restrictive reading of the broad medical consent power. The plain language of the statute supports the opposite conclusion. This is so because where the Legislature intended specific court approval for certain types of treatment, the Legislature expressly provided for that approval in the statute. See Minn.Stat. § 524.5 — 313(c)(4)(i) (requiring specific court approval “for psychosurgery, electroshock, sterilization, or experimental treatment of any kind”).
Tschumy relies on this same statutory language and argues that the language requiring court approval before a guardian may consent to psychosurgery, electroshock, sterilization, or experimental treatment of any kind supports the conclusion that guardians should similarly be required to seek court approval before removing life support. He contends that because these extraordinary powers “are by their nature, life changing with permanent and unknown consequences and side effects,” terminating life support “should be in the same category.” This argument, however, is fundamentally a policy argument rather than one based on the language of the statute.
The statute uses very broad language, providing the guardian with authority to give any necessary consent for necessary medical care and treatment, except for the four listed types of treatment that require court approval. Minn.Stat. § 524.5-313(c)(4)(i). The statutory language confirms that the Legislature did not intend that guardians come back to court to receive specific court permission to consent to the removal of a ward’s life support. See also In re Welfare of Colyer, 99 Wash.2d 114, 660 P.2d 738, 747 (1983) (declining to read the withdrawal of life-sustaining treatment into the Washington statute enumerating four exceptions to a guardian’s authority to make medical decisions).
Tschumy also argues that our decision in In re Torres compels the conclusion that the guardian did not have the authority to authorize removal from life support. 357 N.W.2d 332. In our view, Torres does not compel either result the parties advocate. In Torres, we held that probate courts have the authority to authorize the removal of life support from a comatose ward, eve