CA judge halts end-of-life decision making for incompetent nursing home residents

A California county judge has ordered state health officials to stop allowing doctors to make end-of-life decisions for nursing home patients.

Superior Court of Alameda County Judge Evelio Grillo issued the order Jan. 27 after ruling a 1992 state law violates residents' constitutional rights to decide their own course of treatment, either themselves or through a surrogate. The 1992 law, the first of its kind in the nation, authorized nursing home physicians to administer psychiatric drugs or make end-of-life decisions for patients they consider mentally incompetent. Physicians are not required to tell residents they have been declared incompetent.  

However, Grillo temporarily suspended enforcement of his order while the state Department of Public Health decides whether to implement or appeal the decision.

"The court acknowledges that this order will likely create problems in how many skilled nursing facilities currently operate," Grillo wrote in his June 2015 decision. "The court has considered this burden and weighed it against due process concern, and finds that the due process rights of these patients is more compelling. The states are simply too high to hold otherwise."

As many as 10,000 California nursing home residents have been declared incompetent and have no one designated to represent them, says Mort Cohen, a Golden Gate University law professor who argued the lawsuit on behalf of California Advocates for Nursing Home Reform, to the San Francisco Gate.

The suit was filed in 2013 after a nursing home resident was declared incompetent and fed through a feeding tube at his doctor’s discretion. Nursing home staff asked the resident if he wanted to live or die. He didn’t answer, so they disconnected his tube, revoked an order for life-sustaining care and sent him to hospice. He died two months later, according to the suit.

Related: End-of-life care and resident choice


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