The common law principle is well-settled that every individual of sound mind and adult years has a right to determine what should be done with his or her own body. The right to accept or reject medical treatment has long been recognized for competent adults. However, for individuals who lack capacity, this right was not always recognized, often times forcing individuals to be subjected to treatments that went against their beliefs and desires. Unfortunately, the imposition of unwanted medical treatment still happens today in the context of incapacitated patients who reside in hospitals and nursing homes due to an apparent conflict between limitations placed on the powers of a guardian in some court jurisdictions versus the standards set forth under the Family Health Care Decisions Act.

Signed into law in 2010, the Family Health Care Decisions Act (FHCDA) (N.Y. PUB. HEALTH LAW §2994-d) reflected a major departure regarding the standard under which life sustaining treatment may be terminated for a mentally incompetent person. The FHCDA flipped the switch from the prior “presumption of life” to a “presumption of termination” (absent indication from the principal to the contrary), and did so especially in the context of artificial nutrition and hydration. See In re Zornow, 919 N.Y.S.2d 273, 31 Misc.3d 450 (Sup. Ct. Monroe Cty. 2010).

Intending to fill a gap in New York law by establishing a decision-making process applicable for patients lacking decision-making capacity in hospitals and nursing homes who do not have advance directives, the FHCDA allows surrogate decisions regarding the withdrawal or withholding of life-sustaining treatment based on a best interests standard, subject to the medical standards set forth in the statute. See N.Y. PUB. HEALTH Law §2994-d(4); see also In re Doe, 37 N.Y.S.3d 401, 53 Misc.3d 829 (Sup. Ct. Kings Cty. 2016). Guardians pursuant to Article 81 of New York's Mental Hygiene Law are given the highest priority to act as a surrogate decision maker, followed by a priority order of family members and other persons close to the patient.