## Facts

- Mary C. Northern, about 72, was hospitalized with pneumonia; physicians also diagnosed severe gangrene in both feet.
- Doctors testified bilateral amputation was the only realistic treatment to prevent imminent death.
- Northern refused surgery, denied she had gangrene, and claimed the blackened condition was merely “dirt” or “soot” that would clear without intervention.
- The Tennessee Department of Human Services filed in chancery court under the Protective Services for Elderly Persons statute, alleging Northern lacked capacity to consent and seeking authority to provide protective services, including consenting to surgery.
- The chancery court appointed a guardian ad litem, found Northern in imminent danger of death, found her incapable of consenting to necessary treatment, and authorized the Department to make medical decisions, including consent to amputation.
- The guardian ad litem appealed, disputing the incompetency finding and challenging the statute’s use to override Northern’s refusal.
- The Court of Appeals reviewed the record and personally visited Northern in the hospital to assess her understanding of her condition.

## Issues

1. Whether the protective-services statute permits the state, consistent with due process, to obtain judicial authorization to provide medical treatment for an elderly person who refuses treatment but is alleged to lack capacity to consent.
2. Whether Northern lacked decision-making capacity to consent to or refuse the recommended amputations.
3. What limits and safeguards must constrain any court order authorizing nonconsensual medical treatment.

## Decision

- The court held the statute authorized the Department, acting for the state, to seek judicial approval to provide necessary medical care to an elderly person who lacks capacity to consent.
- The court affirmed the finding that Northern lacked capacity to make an informed decision about amputation because she could not understand her condition and the consequences of refusing treatment.
- The court affirmed the order in principle but modified it to permit surgery only upon physicians’ certification that the procedure was immediately necessary to save Northern’s life.

## Legal Principles

- A competent adult generally may refuse even life-saving treatment; however, the state may act under parens patriae to protect a person who lacks capacity to make an informed medical decision.
- Capacity is decision-specific; intact memory and coherent conversation do not preclude incapacity where the person cannot understand the nature of the condition, proposed treatment, and consequences of refusal.
- A protective-services order authorizing medical treatment over objection must be supported by evidence of incapacity and necessity and must be narrowly limited to the demonstrated, imminent, life-threatening need.
- Due process is satisfied where the state proceeds by formal petition and judicial hearing with representation for the person affected (including appointment of a guardian ad litem) and judicial findings on incapacity and need.

## Conclusion

The court upheld Tennessee’s use of its protective-services statute to authorize life-saving medical treatment for an elderly patient who refused care but lacked capacity to understand her condition, while narrowing the authorization to surgery certified as immediately necessary to prevent death.


State Department of Human Services v. Northern, 563 S.W.2d 197 (Tenn. Ct. App. 1978)