## Facts

- J.M., a 42-year-old woman, was admitted to a hospital in critical condition with end-stage renal disease and related complications.
- Treating nephrologists determined dialysis was immediately necessary to prevent death from progressive organ failure and that no alternative treatment existed.
- J.M. refused dialysis but consented to other life-saving measures and declined to sign a do-not-resuscitate order.
- J.M. stated she would not die without dialysis because Jesus would cure her; psychiatric evaluations addressed whether this belief prevented her from understanding the consequences of refusal.
- J.M. had no advance directive and no health care proxy; her only identified family was a 17-year-old son.
- The hospital filed an emergency application under N.J. Ct. R. 4:86-12 seeking appointment of a special medical guardian to consent to dialysis.

## Issues

1. Whether J.M. had decision-making capacity to refuse life-saving dialysis, particularly whether she understood and appreciated that refusal would likely be fatal.
2. If J.M. lacked capacity, whether the court could authorize dialysis over her expressed refusal by appointing a special medical guardian in an emergency.

## Decision

- The court granted the hospital’s application.
- The court found by clear and convincing evidence that J.M. was incompetent to refuse dialysis because she denied she would most likely die without it.
- The court appointed a special medical guardian with authority to consent to dialysis on J.M.’s behalf.

## Legal Principles

- A competent adult generally has the right to refuse medical treatment, including life-saving treatment.
- When an adult lacks decision-making capacity in a life-threatening situation, the court may act under its parens patriae authority to protect the individual and preserve life.
- In proceedings that limit an adult’s right of self-determination, incapacity must be established by clear and convincing evidence.
- Capacity turns on the ability to understand and appreciate the nature of the condition, the proposed treatment, and the likely consequences of accepting or refusing treatment; a belief framed as religious that negates appreciation of likely death may support a finding of incapacity.
- Appointment of a special medical guardian may be used as a narrow, decision-specific remedy where no authorized surrogate or advance directive exists.

## Conclusion

The court authorized life-saving dialysis by appointing a special medical guardian after finding, by clear and convincing evidence, that J.M. lacked capacity to refuse dialysis because she could not accept or appreciate that refusal would likely result in death.


In re J.M., 416 N.J. Super. 222, 3 A.3d 651 (N.J. Super. Ct. Ch. Div. 2010)