## Facts

- D.L.H. was a 53-year-old man with profound intellectual disability since birth and had always lacked capacity to make health-care decisions.
- He lived in a state-operated facility, and his parents were appointed plenary guardians of his person.
- In 2007, he developed aspiration pneumonia, which physicians considered curable and nonterminal.
- Treating physicians determined mechanical ventilation was necessary to preserve his life.
- The guardians objected and sought to refuse mechanical ventilation as not in his best interests.
- The facility and the Department of Public Welfare proceeded with ventilation over the guardians’ objection.
- The guardians petitioned the orphans’ court to be appointed as health-care agents under Pennsylvania’s advance directive/health-care decision statute to permit refusal of life-preserving treatment without further court involvement.
- By the time the courts ruled, D.L.H. had recovered; the courts addressed the dispute as capable of repetition yet evading review.

## Issues

1. Whether plenary guardians, under Pennsylvania’s guardianship statute alone, may refuse life-preserving medical treatment for an incapacitated person who has never had decision-making capacity and is neither end-stage nor permanently unconscious.
2. Whether the power to withhold life-preserving treatment is controlled by Pennsylvania’s health-care decision statute rather than implied within the general powers of plenary guardianship.
3. Whether a court may recognize an extra-statutory “best interests” authority for guardians to refuse life-preserving treatment in these circumstances.

## Decision

- The Supreme Court of Pennsylvania affirmed the order denying the guardians’ petition.
- A plenary guardian does not, by virtue of guardianship status alone, have authority to refuse life-preserving treatment for a never-competent person who is not end-stage and not permanently unconscious.
- Authority concerning refusal of life-preserving treatment is controlled by Pennsylvania’s health-care decision statute and cannot be conferred through the general guardianship statute.

## Legal Principles

- Courts may not grant guardians powers “controlled by other statute” under 20 Pa.C.S. § 5521(f); the statutory examples are illustrative, not exhaustive.
- Where the legislature has created a specific statutory regime assigning and limiting authority to withhold life-preserving treatment (e.g., through health-care agents or representatives), that regime governs.
- Absent reliable evidence of the patient’s own prior expressed wishes (no prior competent refusal and no advance directive), courts should not expand guardianship powers beyond the governing statutory framework to permit refusal of life-preserving care.

## Conclusion

Pennsylvania law does not allow plenary guardians to unilaterally refuse life-preserving treatment for an incapacitated person who has always lacked capacity and is not terminal or permanently unconscious; decisions about withholding such treatment must proceed, if at all, under the specific health-care decision statute rather than through implied guardianship authority.


In re D.L.H., 606 Pa. 550, 2 A.3d 505 (Pa. 2010)