In re J.L.S.

\COURT OF CHANCERY
OF THE
STATE OF DELAWARE
PAUL A. FIORAVANTI, JR. LEONARD L. WILLIAMS JUSTICE CENTER
VICE CHANCELLOR 500 N. KING STREET, SUITE 11400
WILMINGTON, DELAWARE 19801-3734

March 24, 2026

Lawrence Lee Wentz, Esquire D.A.M.
521 N West St [Redacted]
Wilmington, DE 19801

RE: In re J.L.S., a person with an alleged disability,
C.M. No. 20912-K-PAF

Dear Counsel, Ms. D.A.M.:

This letter decision memorializes the court’s prior oral ruling that denied an

emergency petition to change the code status of J.L.S., a person with an alleged

disability. J.L.S. died shortly after the court’s oral ruling. This decision highlights

a conflict between the recently adopted statute governing health-care decisions and

the concomitant Court of Chancery Rule.

I. BACKGROUND

A. The Person with an Alleged Disability

J.L.S. was an 86-year-old individual residing at a hospital facility in Kent

County, Delaware.1 He and his spouse, V.S., had been married for approximately

1
Dkt. 17 (“Emergency Petition”) ¶ 1; Dkt. 1 (“Guardianship Petition”) ¶¶ 1, 3(c),
3(e)(i)−(ii).
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46 years. Their family included two adult sons from V.S.’s prior marriage.2 On

April 18, 2024, J.L.S. was admitted to the [Redacted] (the “Hospital”).3 Until that

time, he resided in Delaware with his spouse and one of his stepsons, M.M.4

B. Factual Background

1. Medical history and J.L.S.’s capacity preceding the
guardianship

On April 18, 2024, J.L.S. was admitted to the Hospital after being diagnosed

with dehydration and pneumonia.5 This marked the fourth time that J.L.S. had been

hospitalized in 2024.6 He had reportedly been bedridden for approximately six

months, and his medical history included lymphoma and bilateral knee arthritis.7

On April 23, 2024, Nurse Practitioner R.M. provided approximately

94 minutes of combined face-to-face and non-face-to-face care to J.L.S.8 During

that visit, V.S. stated she did not believe that she could care for her husband at home,

even with hospice support.9 R.M.’s notes reflect potential uncertainty regarding end-

2
Emergency Petition Ex. B.
3
Id. ¶ 1; Guardianship Petition ¶¶ 1, 3(c), 3(e)(i)−(ii).
4
Guardianship Petition ¶ 4(c).
5
Id. ¶ 3(e)(iv); id. Ex. B.
6
Emergency Petition Ex. B.
7
See Emergency Petition Exs. B, E.
8
Id. Ex. B.
9
Id.
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of-life care. One entry indicates that J.L.S. said that he had been “ready to die, when

it’s his time.”10 V.S., however, expressed that she wanted her husband “to try to

participate with therapy if possible.”11 Both were described as favoring avoidance

of “aggressive, or artificial measures to prolong [J.L.S.’s] life.”12

10
Id.
11
Id.
12
Id.
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At the same time, the medical record listed J.L.S.’s code status as “full code”13

and included a statement attributed to him that “[he] just can’t die.”14 But when

asked specifically about resuscitation, he stated, “I don’t want it, let me go!”15 The

record further reflects that J.L.S. described himself as “miserable” with his quality

of life because of immobility and knee pain and that he “just want[ed] to sleep and

eat.”16 The April 23 assessment anticipated that J.L.S. would “likely progress to

13
“A full code or code blue involves calling a rapid response team and initiating
appropriate treatment as quickly and effectively as possible with the goal of reversing an
adverse event, returning patients to the status they had before the event that triggered the
full code and restoring as high a level of functioning as possible. It is an emergency
intervention with high priority, and speed is often critically important. A full code,
properly executed, is often life-saving.” Forman & Ladd, Why Not a Slow Code?, 14 AMA
J. Ethics 759, 760 (2012). “‘[F]ull code’ represents a patient’s request for a physician to
use any clinically indicated medical intervention(s) to save that patient’s life.” Simon J.W.
Oczkowski et al., Withdrawing versus not offering cardiopulmonary resuscitation: Is
there a difference?, 22 Can. Respir. J. 20 (2015); see also Kim Jordan et al., Associations
with resuscitation choice: Do not resuscitate, full code or undecided, 99 Patient Educ.
Couns. 823, 824 (2016) (“In [the] absence of a D[o] N[ot] R[esuscitate] order, the
individual by default is ‘full resuscitation’, often termed ‘full code’ (FC), and will undergo
endotracheal intubation, assisted ventilation, chest compressions, defibrillation, and
cardiotonic drugs when appropriate.”); Hamilton v. Negi, 2014 WL 1388260, at *4 n.6
(W.D. La. Mar. 31, 2014) (“Full code” “means a patient is to receive all resuscitative
measures, which can include nutritional support, intubation, and/or chest compressions, in
end-of-life situations.”), aff’d, 595 F. App’x 346 (5th Cir. 2014).
14
Emergency Petition Ex. B.
15
Id.
16
Id.
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C.M. No. 20912-K-PAF
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end-of-life within . . . 6 months.”17 According to the record, J.L.S. was forgetful,

but demonstrated some insight into his medical condition and wishes.18

On April 24, 2024, R.M. met again with J.L.S. and V.S. for 80 minutes to

review goals of care.19 During that meeting, J.L.S. completed a Delaware Medical

Orders for Scope of Treatment form (the “DMOST”). The executed DMOST

reflects that J.L.S. declined resuscitation, intubation, mechanical ventilation, and

artificial nutrition.20 The record of the April 24 visit indicated that J.L.S. was

considered “medically stable for discharge,” but his wife reiterated that she could

not provide care for him at home.21

On May 21, 2024, J.L.S. experienced an episode of supraventricular

tachycardia.22 He was treated with, and responded to, adenosine.23 Several months

later, on October 25, 2024, Dr. M.A. documented that J.L.S. required high-

complexity medical decision-making because he was “critically ill due to atrial

17
Id.
18
Id.
19
Emergency Petition Ex. C.
20
See Dkt. 15 Ex. at 1.
21
Emergency Petition Ex. C.
22
Emergency Petition Ex. E.
23
Id.
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tachycardia with hypotension.”24 J.L.S. was admitted to the intensive care unit that

day. According to the medical record, J.L.S. “changed his code status [from Do Not

Resuscitate (‘DNR’)] to full code and had capacity to make th[at] decision.”25 The

same record shows that he received three 6 mg doses of adenosine that day during a

rapid response event for supraventricular tachycardia and hypotension.26

2. The guardianship proceedings

On June 27, 2025, the Hospital filed a petition to appoint a guardian for J.L.S.

(the “Guardianship Petition”).27 The Guardianship Petition indicated that J.L.S.

suffered from “severe cognitive impairment affecting orientation, capacity for

medical decision making, recall, and attention with diminished language

processing.”28 The petition was supported by an affidavit from M.R.M., D.O. (the

“M.R.M. Affidavit”).29 The M.R.M. Affidavit described a June 19, 2025 evaluation

that included a Mini-Mental State Examination (“MMSE”). J.L.S. scored 15 out of

24
Id.
25
Id.
26
Id.
27
Dkt. 1. As is typical with most guardianship petitions, the matter was assigned to a
Magistrate in Chancery.
28
Guardianship Petition ¶ 10; see also M.R.M. Aff. (Dkt. 1) at 2−3 (reporting cognitive
impairment following a 45-minute visit on June 19, 2025).
29
M.R.M. Aff. at 2.
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30 on the MMSE, which was characterized as “abnormal” and indicative of “severe

cognitive impairment.”30

The M.R.M. Affidavit noted that J.L.S. suffered from sensorineural hearing

loss and described aspects of his cognitive functioning. According to the M.R.M.

Affidavit, J.L.S. was able to identify the season, month, state, country, town, and

Hospital location; name common objects (i.e., a pencil and a watch); follow a multi-

step command (“Take a paper in your hand, fold it in half, and put it on the floor”);

read and comply with the instruction (“Close your eyes”); and write a sentence.31

He was unable, however, to identify the year, date, and day; spell “world”

backwards; recall previously stated words (“pin, fork, and bottle”); or repeat the

phrase “No ifs, ands, or buts.”32 The M.R.M. Affidavit also indicates that J.L.S. was

unable to copy a displayed design.33

The Guardianship Petition and the M.R.M. Affidavit stated that J.L.S. was

“unable to perform activities of daily living, [] require[d] total care,”34 and that his

30
Id.
31
Id. at 4.
32
Id.
33
Id.
34
Guardianship Petition ¶ 10; see M.R.M. Aff. at 3.
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condition impaired his “medical decision-making” capacity.35 The Hospital

represented that it filed the Guardianship Petition because V.S. had been unwilling

to assist with applying for Medicaid long-term care benefits or arranging for J.L.S.

to return home.36 The Guardianship Petition identified D.A.M., a geriatric care

manager at [Redacted] (the “Guardian”), as proposed guardian of the person and

property.37

On July 21, 2025, the Magistrate appointed an attorney ad litem (the “Former

AAL”) to represent J.L.S.’s best interests.38 On August 7, 2025, the Former AAL

connected with J.L.S. for a video call using FaceTime.39 J.L.S. was resistant to

engaging with the Former AAL, and he consistently and unequivocally objected to

the appointment of a guardian. The Former AAL noted that J.L.S. had shown some

awareness of the proceedings and expressed a desire that his wife act as his agent.40

The Former AAL also described J.L.S. as agitated during the interaction.41

35
M.R.M. Aff. at 2.
36
Guardianship Petition ¶ 10.
37
Id. ¶ 11; see also Guardian Consent (Dkt. 1).
38
Dkt. 2 ¶ 2.
39
Dkt. 3 (hereinafter “AAL’s Letter”) ¶ 2.
40
AAL’s Letter at 2.
41
Id.
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C.M. No. 20912-K-PAF
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On August 12, 2025, the Magistrate informed J.L.S. by letter that, if he

remained opposed to the Guardianship Petition, he needed by September 12, 2025

to retain counsel, submit a written objection, or contact the court to request the

appointment of counsel.42 In the absence of any action, the Magistrate would hold

a guardianship hearing on September 19, 2025.43

On August 22, 2025, the Former AAL filed a four-page written report (the

“AAL Report”).44 In the AAL Report, the Former AAL recounted her second

attempt to meet with J.L.S. via videoconference on August 13, 2025. According to

the AAL Report, J.L.S. was very agitated, began singing, and made noises that

appeared intended to drown out communication; he “emphatically [did] not want to

discuss his situation and reiterate[d] that ‘[his] wife [wa]s [his] agent.’”45 The

Former AAL further reported that she had written to V.S. and M.M., but received no

response. The Former AAL concluded that J.L.S.’s circumstances “require[d]

resolution and [] long-term placement” which could not occur without the

42
Dkt. 5 at 2.
43
Id.
44
Dkt. 6.
45
Id. ¶ 2.
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C.M. No. 20912-K-PAF
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appointment of a guardian because J.L.S.’s family appeared unwilling or unable to

assist him.46

On September 2, 2025, V.S. contacted the Register in Chancery and objected

to the appointment of a fee-for-service guardian of the property, but did not object

to the appointment of a guardian of the person.47 The Register’s office provided

V.S. with a cross-petition and set a deadline of September 13, 2025 for its

submission.48

V.S. did not file a cross-petition or objection, and at a hearing on

September 19, 2025, the Magistrate appointed the Guardian of J.L.S.’s person and

property.49

3. Code status developments following the appointment of the
Guardian

On January 13, 2026, J.L.S. tested positive for Influenza A.50 After his

condition worsened, J.L.S. was transferred to the intensive care unit on January 15,

2026, where he was started on vasopressors and closer respiratory monitoring.

46
Id. ¶¶ 2−3, 7. The Former AAL reported fees totaled $2,145. Id. ¶ 9; see also Affidavit
of Legal Fees (Dkt. 6); Affidavit of Legal Fees Ex. A.
47
Dkt. 7.
48
Id.
49
Dkt. 9 at 2.
50
Dkt. 15 Ex. at 9.
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Documentation from that admission by R.M. indicates that J.L.S. was awake, alert,

oriented to person and place, and minimally oriented to situation. R.M. also

documented that J.L.S. stated his desire to remain full code, consistent with prior

code-status discussions.51

R.M.’s notes also reflect a conversation with the Guardian’s representative,

who stated that she had not been informed of the deterioration of J.L.S.’s condition.52

The Guardian’s representative expressed the belief that J.L.S.’s decision for full code

status reflected his perception that he was receiving good care and that placement in

a long-term care facility was being pursued.53 The Guardian’s representative

indicated that she would respect J.L.S.’s wishes but requested updates should his

condition change.54

J.L.S. was transferred out of the intensive care unit on January 24, 2026, but

returned two days later and was placed on mechanical ventilation. He remained

ventilator-dependent for the ensuing weeks leading up to the filing of the emergency

petition.55

51
See id.
52
See id.
53
See id.
54
See id.
55
Dkt. 17 (the “Emergency Petition”) ¶ 1; Emergency Petition Ex. A ¶ 5.
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4. The Emergency Petition

On February 2, 2026, the Guardian emailed this court seeking guidance

regarding an end-of-life decision for J.L.S. The email acknowledged that J.L.S. had

elected full code status in October 2024. The Magistrate responded by letter,

indicating that any change in code status would need to be sought by petition

pursuant to Court of Chancery Rule 178-A and consistent with 16 Del. C. § 2522.56

The Magistrate also urged the Guardian to consult independent legal counsel

regarding available options and further proceedings.

The Guardian did not retain separate counsel for purposes of the emergency

petition. Instead, the Guardian’s representative conferred with the Hospital’s in-

house general counsel, who prepared the emergency petition. Both the Guardian

and the Hospital’s counsel have acknowledged that the Hospital’s counsel did not

represent the Guardian.

C. Procedural History

On February 13, 2026, the Guardian filed the emergency petition (the

“Emergency Petition”).57 The Emergency Petition sought authorization for the

56
Dkt. 16.
57
Emergency Petition. On February 13, 2026, the Guardian notified V.S. and M.M. of the
Emergency Petition. Id. Ex. F.
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Guardian to (i) change J.L.S.’s code status, (ii) withdraw life-sustaining treatment,

(iii) forgo reintubation in the event of respiratory failure, and (iv) transition J.L.S. to

comfort-focused, palliative care.58 The record does not reflect that the Guardian’s

representative had a direct conversation with J.L.S. concerning his code status

following the January 2026 admission to the intensive care unit.

The Emergency Petition was supported by two physician affidavits.

According to the affidavits, each physician independently evaluated J.L.S. on

February 12, 2026 for approximately 10 minutes.59 Both reported that he was

ventilator-dependent, in shock requiring vasopressors, experiencing cardiac

arrhythmia, and suffering worsening hypoxia secondary to heart failure despite

diuretic therapy. Both physicians recommended withdrawal of mechanical

ventilation and transition to comfort-focused palliative care.60 Neither physician

recommended tracheostomy or percutaneous endoscopic gastrostomy (“PEG”)

placement, citing J.L.S.’s vasopressor dependence, progressive hypoxia, altered

mental status, lack of responsiveness to aggressive medical therapy, baseline frailty,

58
Emergency Petition 1, ¶¶ 13–14.
59
Emergency Petition Ex. A.
60
Id.; S.N.M. Aff. ¶ 6; R.G. Aff. ¶ 6.
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and poor quality of life.61 One of the two physicians further documented profound

malnutrition, multi-organ failure, and significant weakness.62

On February 14, 2026, the court appointed Lawrence Lee Wentz, Esquire, as

attorney ad litem (the “AAL”) for purposes of the Emergency Petition and requested

that he provide an oral report at the hearing and consult with J.L.S.’s family

members.63

On February 16, 2026, the court held a hearing by videoconference on the

Emergency Petition.64 The court heard testimony from V.S., the Guardian’s

representative, the AAL, and the two treating physicians, Dr. S.N.M. and Dr. R.G.,

who submitted affidavits in support of the Emergency Petition.65 When questioned

about tracheostomy and PEG placement, the physicians confirmed that J.L.S. was

medically eligible for a tracheostomy and that the risks he would face were the same

as those faced by other similarly situated patients.66 Dr. R.G. testified that J.L.S.

61
S.N.M. Aff. ¶ 9; R.G. Aff. ¶ 9.
62
S.N.M. Aff. ¶ 11.
63
Dkt. 19.
64
Dkt. 21 (“Hearing Judicial Action Form”).
65
Id. V.S. was only able to join the call by audio. The court was dismayed in learning that
V.S. had not been timely informed that J.L.S.’s condition had deteriorated, that he was
transferred to the intensive care unit, and that he had been placed on mechanical ventilation.
Id.
66
Id. at 1−3.
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was unlikely to improve following a tracheostomy. In Dr. R.G.’s view, the

procedure would have prolonged J.L.S.’s life but would not have improved the

quality of life or resulted in a meaningful recovery.67

Each witness who testified supported the relief requested in the Emergency

Petition. The court did not hear testimony from R.M., who had interacted with J.L.S.

during his April 2024 admission in connection with the DMOST execution and

during the January 2026 intensive care unit admission, when she documented his

confirmation of full code status.

The court denied the Emergency Petition at the end of the hearing.68 Two

days later, on February 18, 2026, the court issued a bench ruling articulating the

reasoning for denying the Emergency Petition.69

II. ANALYSIS

A. The Court’s Authority and the Interaction between 16 Del. C.
§ 2522 and Court of Chancery Rule 178-A

“Among the most difficult questions presented in late twentieth century law

are those that arise from the social effects of new health care technologies that extend

our ability to sustain life . . . at its last stages;” courts—though “imperfect

67
Id. at 3.
68
Id. at 4.
69
Dkt. 23.
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institutions”—must decide cases “as they are properly presented.” In re Gordy, 658

A.2d 613, 614 (Del. Ch. 1994). So too here.

Delaware law respects a core principle of human autonomy: “Fundamental

to human liberty is the right to autonomy over one’s own body, including freedom

to choose what medical treatment shall be imposed upon one’s body.” In re L.M.R.,

2008 WL 398999, at *2 (Del. Ch. Jan. 24, 2008); see also In re A.J., 2023

WL 4980719, at *2 (Del. Ch. Mar. 10, 2023). But when an individual cannot

exercise that autonomy, the court may be asked to authorize a surrogate decision.

See Severns v. Wilm. Med. Ctr., Inc., 421 A.2d 1334, 1349–50 (Del. 1980). The

Court of Chancery has authority to honor that request following an evidentiary

hearing. Id. at 1349.

In 2024, the General Assembly adopted the Uniform Health-Care Decisions

Act of 2023 (the “Act”), amending Title 16 of the Delaware Code. The amendments

became effective on September 30, 2025. The Act defines a “health-care

instruction” as “a direction, whether or not in a record, made by an individual that

indicates the individual’s goals, preferences, or wishes concerning the provision,

withholding, or withdrawal of health care.” 16 Del. C. § 2502(14). A later

instruction that conflicts with an earlier one revokes the earlier “to the extent of the

conflict.” 16 Del. C. § 2507(c). The Act presumes that an individual has capacity
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unless that presumption is rebutted pursuant to the statutory mechanism. 16 Del. C.

§ 2504(a)–(b). Capacity requires that “an individual [be] willing and able to

communicate a decision independently or with appropriate services . . . and, in

making or revoking . . . [a] health-care decision, understands the nature and

consequences of the decision, including the primary risks and benefits of the

decision.” 16 Del. C. § 2503.

The Act imposes a substantive limitation on a guardian’s authority. A

guardian may refuse to comply with, or revoke, an advance health-care directive

“only if the court appointing the guardian issues an order expressly permitting the

acts taken by the guardian.” 16 Del. C. § 2522(a). That requirement governs the

scope of the guardian’s power where the guardian seeks to act inconsistently with

the individual’s health-care instruction.

In conjunction with the adoption of the Act, this court amended Court of

Chancery Rule 178-A to “remove outdated references, repealed by the Act, and

clarify the powers of guardians on issues concerning life-sustaining treatment for a

person with disabilities.”70 Rule 178-A(a) provides that a guardian “may not change

70
See Press Release, Delaware Court of Chancery, The Court of Chancery Amends and
Adds New Rules Affecting the Magistrate Docket to Address the Incoming Title 16 Cases
and Improve Guardianship Procedures (Sept. 23, 2025).
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a person with a disability’s code status or direct medical providers to withhold or

withdraw . . . mechanical ventilation . . . unless [(a)] . . . [a] medical provider

confirms . . . a major reduction in health or functional ability from which the

individual is not expected to recover,” or (b) the guardian obtains prior court

approval. Ct. Ch. R. 178-A(a).

Rule 178-A had the unintended effect of creating a conflict with the Act.

Under the Act, a guardian seeking to revoke or not comply with a health care

directive must obtain court approval, whereas Rule 178-A permits the guardian to

do so either with court approval or upon a medical provider’s confirmation that the

individual has had a major reduction in health or functional ability from which the

person is not expected to recover. This conflict between the Act and the Rule is

easily resolved in favor of the Act.

Section 361(a) of Title 10 of the Delaware Code permits the court to adopt

rules of practice and procedure “with respect to . . . proceedings in [this] Court.” But

Section 361(b) limits that rule-making authority, expressly providing that “[t]he

[Court of Chancery] [R]ules shall not abridge, enlarge or modify any substantive

right of any party.” 10 Del. C. § 361(b); see Nelson v. Frank E. Best Inc., 768 A.2d

473, 490 (Del. Ch. 2000) (observing that the court’s rules may not “override . . . any

statutory provision duly enacted by our General Assembly”).
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The Guardian proceeded under Court of Chancery Rule 178-A. The

physicians’ affidavits and testimony established that J.L.S. was ventilator-

dependent, in shock requiring vasopressors, experiencing arrhythmia, and suffering

worsening hypoxia due to heart failure despite diuretic therapy. The physicians

opined that J.L.S. was not expected to recover and was unlikely to survive this

hospitalization. That medical record satisfies the type of “major reduction in health

or functional ability” contemplated by Rule 178-A(a)(1). But Section 2522(a) of the

Act imposes a substantive limitation on a guardian’s authority to disregard an

individual’s health-care directive. Because that statutory requirement governs the

scope of the guardian’s authority, it controls. Accordingly, notwithstanding the

medical evidence of irreversible decline, the Guardian must obtain court

authorization before directing withdrawal of mechanical ventilation or otherwise

acting inconsistently with J.L.S.’s health-care instruction.

B. The Governing Standard

When this court appoints a guardian, it entrusts the guardian to “engage in a

fully-informed decision-making process” and to rely on appropriate medical and

professional advice. See In re A.R., 2025 WL 2017280, at *7 (Del. Ch. June 27,

2025) (quoting In re M.G., 2022 WL 20470845, at *4 (Del. Ch. Jan. 31, 2022)).

“This [c]ourt and any guardian are required to advance the best interest of the person
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with a disability.” Id. (citing Gordy, 658 A.2d at 618). If the individual can express

their wishes rationally, the court must consider them. Id.

The Act gives primacy to an individual’s health-care instructions when made

with capacity. 16 Del. C. §§ 2503−2504, 2507(c), 2515. If the record contains a

later instruction made with capacity that has not been revoked under the Act, the

court’s task is correspondingly narrow. The court must determine whether the

proposed course of action reflects the ward’s wishes. See L.M.R., 2008 WL 398999,

at *3. “To ensure that the decision of the guardian[] to terminate life-sustaining

treatment truly represents the wishes of the ward, any decision of this [c]ourt that

the ward would wish to refuse such treatment must be supported by evidence that is

clear and convincing.” Id. (citing In re Tavel, 661 A.2d 1061, 1070 (Del. 1995)).

Under Delaware law, clear and convincing evidence produces in the

factfinder’s mind an “abiding conviction” that the factual contention is “highly

probable, reasonably certain, and free from serious doubt.” In re G.S., 2022

WL 20471650, at *3 (Del. Ch. July 1, 2022) (quoting Hudak v. Procek, 806 A.2d

140, 147 (Del. 2002)). In this setting, “medical evidence is of significant

importance.” Id. (quoting Brittingham v. Robertson, 280 A.2d 741, 743 (Del. Ch.

1971)). Yet medical evidence does not displace the requirement that the court

evaluate “all factors relevant to the ward’s ‘personal value system,’ including prior
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statements relevant to the ward’s current medical condition and ‘all facets’ of the

personality of the ward.” L.M.R., 2008 WL 398999, at *3 (quoting Tavel, 661 A.2d

at 1069).

Cases of this nature present the “weightiest questions . . . touching on the

profound values of life, dignity, and family.” In re W.E., 2025 WL 3540216, at *1

(Del. Ch. Dec. 10, 2025). In addressing those questions, the court acts as a

“conscientious steward for one who can no longer advocate for his own safety.” Id.

Where the record contains a valid, later health-care instruction made with capacity,

the substituted judgment inquiry does not permit the court to override that instruction

absent statutory grounds for invalidation or revocation.

C. J.L.S. Revoked the April 2024 DMOST

The Act presumes capacity unless rebutted. 16 Del. C. § 2504. Under the

Act, health-care instructions, including those documented in medical records, may

be revoked. Revocation may be effected “by any act . . . that clearly indicates”

intent, “including an oral statement to a health-care professional,” so long as the

individual has capacity under the Act. 16 Del. C. § 2515(a)(1), (b).

These provisions are central to this case. In April 2024, J.L.S. executed a

DMOST declining resuscitation, intubation, mechanical ventilation, or artificial

nutrition. The contemporaneous palliative care notes reflect statements consistent
In re J.L.S., a person with an alleged disability,
C.M. No. 20912-K-PAF
March 24, 2026
Page 22 of 26

with that directive—namely that he was “ready to die when it is his time,” did not

want aggressive or artificial measures to prolong life, and expressed distress with his

quality of life due to immobility and pain. But the record does not end there. On

October 25, 2024, during an intensive care unit admission for atrial tachycardia with

hypotension, J.L.S. changed his code status from DNR to full code.71 It is both

documented and undisputed that J.L.S. “had capacity to make the decision” at that

time.72 The same record indicates that he was administered a total of 18 mg of

adenosine that day, in three 6 mg doses.73

During the court’s emergency hearing on February 16, 2026, Dr. S.N.M.

opined that J.L.S.’s decision to elect full code likely occurred in the context of the

adenosine administration—a medication that can temporarily halt the heart’s

electrical activity to reset abnormal cardiac rhythms.74 The suggestion here is that

J.L.S. might have wanted only a temporary change in code status during his

adenosine treatment. But that suggestion is demonstrably weak. Dr. S.N.M. did not

have first-hand knowledge of J.L.S.’s reasoning in October 2024. Rather, the

71
Emergency Petition Ex. E.
72
Id.
73
Id.
74
See Hearing Judicial Action Form.
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C.M. No. 20912-K-PAF
March 24, 2026
Page 23 of 26

physician’s testimony was surmised from the medical records and the timing of the

adenosine administration. In fact, the contemporaneous record itself does not

corroborate that rationale. Indeed, October 25, 2024 was not the first time that J.L.S.

received adenosine treatment.75 Physicians had treated J.L.S.’s supraventricular

tachycardia with adenosine once before—on May 21, 2024, and at that time J.L.S.

did not elect to change his code status.76 In short, Dr. S.N.M.’s observations do not

support the notion that J.L.S. intended only a temporary change in code status in

October 2024 or that he lacked capacity at the time he decided to change his status

to full code.

The Guardian did not seek a finding that the October 2024 full code

instructions were invalid when made, nor did the Guardian present evidence

rebutting the statutory presumption of capacity at that time. The Guardian also did

not offer evidence undermining J.L.S.’s January 2026 statements reaffirming his

desire to remain full code. Under the Act, if the October 2024 full code instruction

was made with capacity, then the April 2024 DMOST was revoked to the extent it

conflicted with the later full code instruction. 16 Del. C. §§ 2507(c), 2515(a)(1), (b).

75
Emergency Petition Ex. E.
76
Id.
In re J.L.S., a person with an alleged disability,
C.M. No. 20912-K-PAF
March 24, 2026
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D. Whether the Court May Authorize Action Inconsistent with the
Full Code Instruction

The Emergency Petition sought authority for the Guardian to direct

withdrawal of mechanical ventilation and to direct that J.L.S. not be reintubated in

the event he could not breathe independently.77 That relief would have required the

court to authorize an action inconsistent with J.L.S.’s recorded full code instruction.

The dispositive question was therefore not whether withdrawal would have been

medically appropriate or whether J.L.S.’s quality of life had deteriorated. The

question also was not whether he expressed reluctance in April 2024 to prolong life

by artificial means. The controlling question presented in the Emergency Petition

was whether the court may authorize the Guardian’s representative to override

J.L.S.’s later full code instruction on this record.

The October 25, 2024 medical record contains an express notation that J.L.S.

“had capacity to make the decision” to change his code status to full code. Although

witnesses offered testimony regarding what they thought might have led to the status

change, the record does not document the reasoning behind J.L.S.’s decision to

change his status. It reflects only that adenosine was administered, that the code

status was changed, and that J.L.S. had capacity. Moreover, the record reflects a

77
Emergency Petition ¶ 14.
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C.M. No. 20912-K-PAF
March 24, 2026
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documented reaffirmation of full code status in January 2026 while J.L.S. was awake

and oriented to person and place. The court did not hear testimony from R.M., who

documented that reaffirmation. The record also does not establish that the

Guardian’s representative had a direct conversation with J.L.S. about code status

when his condition began to deteriorate in January 2026.

The physicians’ testimony regarding prognosis, tracheostomy, PEG

placement, and likely outcomes underscored the gravity of the medical

circumstances. But the Act does not permit a guardian or the court to disregard a

valid health-care instruction solely because of a worsened prognosis. Nor does it

permit the court to substitute its own assessment of the medical prognosis for a

health-care instruction made with capacity. Severns cautions that the court may not

decide “life-and-death matters” without a record sufficient to support relief. 421

A.2d at 1349–50. L.M.R. emphasizes that clear and convincing evidence is required

in these circumstances to ensure that a guardian’s request “truly represents the

wishes of the ward.” 2008 WL 398999, at *3. And W.E. underscores that the court’s

role is that of a “conscientious steward for those who can no longer advocate for

[their] own safety.” 2025 WL 3540216, at *1.

The Guardian did not meet the clear and convincing evidentiary burden to

justify authorizing action inconsistent with J.L.S.’s full code instructions reflected
In re J.L.S., a person with an alleged disability,
C.M. No. 20912-K-PAF
March 24, 2026
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in the record. There is no evidence to support a finding that J.L.S. lacked capacity

when he elected full code status in October 2024, and the Guardian has not sought

such a finding. Consequently, the court did not find that the Guardian’s request to

withdraw life-sustaining treatment “represents the wishes of [J.L.S.].” L.M.R., 2008

WL 398999, at *3.

III. CONCLUSION

Therefore, the Emergency Petition is denied.

IT IS SO ORDERED.

Very truly yours,

/s/ Paul A. Fioravanti, Jr.

Vice Chancellor