Title: In re Sheila W.
Citation: 2013 WI 63
Docket Number: 2012AP000500
State: Wisconsin
Issuer: Wisconsin Supreme Court
Date: July 10, 2013

2013 WI 63 
 
SUPREME COURT OF WISCONSIN 
 
 
 
 
 
CASE NO.: 
2012AP500   
COMPLETE TITLE: 
In the interest of Sheila W., a person under the 
age of 18: 
 
Dane County, 
          Petitioner-Respondent, 
     v. 
Sheila W., 
          Respondent-Appellant-Petitioner.   
 
 
 
 
 
 
REVIEW OF A DECISION OF THE COURT OF APPEALS  
(No Cite)      
 
 
OPINION FILED: 
July 10, 2013   
SUBMITTED ON BRIEFS: 
        
ORAL ARGUMENT: 
April 11, 2013   
 
 
SOURCE OF APPEAL: 
 
 
COURT: 
Dane   
 
COUNTY: 
Circuit   
 
JUDGE: 
William C. Foust   
 
 
 
JUSTICES: 
 
 
CONCURRED: 
PROSSER, J., concurs. (Opinion filed.)   
 
DISSENTED: 
GABLEMAN, ROGGENSACK, ZIEGLER, JJJ., dissent. 
(Opinion filed.)   
 
NOT PARTICIPATING:         
 
 
 
ATTORNEYS: 
 
For the respondent-appellant-petitioner, there were briefs 
by Shelley M. Fite, assistant state public defender, and oral 
argument by Shelly M. Fite.    
 
 
For the petitioner-respondent, there was a brief by Eve M. 
Dorman, assistant corporation counsel, and Dane County, and oral 
argument by Eve M. Dorman. 
  
 
 
2013 WI 63
NOTICE 
This opinion is subject to further 
editing and modification.  The final 
version will appear in the bound 
volume of the official reports.   
No.   2012AP500 
(L.C. No. 
2012JC55) 
STATE OF WISCONSIN  
 
 
   : 
IN SUPREME COURT 
 
 
In the interest of Sheila W., a person under 
the age of 18: 
 
 
 
Dane County, 
 
          Petitioner-Respondent, 
 
     v. 
 
Sheila W., 
 
          Respondent-Appellant-Petitioner. 
 
 
 
FILED 
 
JUL 10, 2013 
 
Diane M. Fremgen 
Clerk of Supreme Court 
 
 
 
 
REVIEW of a decision of the Court of Appeals.  Affirmed.   
 
¶1 
PER CURIAM.   This is a review of an unpublished 
opinion of the court of appeals dismissing this appeal because 
the issues presented are moot.1  The petitioner, Sheila W., is a 
minor who was diagnosed with aplastic anemia.  She opposed on 
                                                 
1 Dane Cnty. v. Sheila W., No. 2012AP500, unpublished slip 
op. (Ct. App. Oct. 31, 2012). 
No. 
2012AP500   
 
2 
 
religious grounds any life-saving blood transfusions and her 
parents supported her position.   
¶2 
The circuit court appointed a temporary guardian under 
Wis. Stat. § 54.50 for the purpose of deciding whether to 
consent to medical treatment.  Sheila W. appealed, but the order 
appointing a temporary guardian expired while the case was 
pending before the court of appeals.  The court of appeals then 
dismissed the appeal, concluding that the issues presented are 
moot and that the appeal does not sufficiently satisfy the 
criteria to address the merits regardless of mootness.  Four 
issues are presented for our review:   
¶3 
First, notwithstanding mootness, should this court 
decide this case on the merits because it involves matters of 
statewide importance that are capable of repetition yet evade 
appellate review?  Second, does Wisconsin recognize the mature 
minor doctrine, which may permit a minor to give or refuse 
consent to medical treatment after a finding that she is 
sufficiently 
mature 
and 
competent 
to 
make 
the 
treatment 
decision?  Third, does a mature, competent minor have an 
enforceable due process right to refuse unwanted medical 
treatment?  Fourth, did the circuit court violate Sheila W.'s 
common law and constitutional right to refuse unwanted medical 
treatment by appointing a temporary guardian to determine 
whether 
to 
give 
consent 
to 
medical 
treatment 
over 
her 
objections?   
¶4 
We address only the issue of mootness.  This court has 
"consistently adhered to the rule that a case is moot when a 
No. 
2012AP500   
 
3 
 
determination is sought upon some matter which, when rendered, 
cannot have any practical legal effect upon a then existing 
controversy."  G.S., Jr. v. State, 118 Wis. 2d 803, 805, 348 
N.W.2d 181 (1984).  In this case, no determination of this court 
will 
have 
any 
practical 
legal 
effect 
upon 
an 
existing 
controversy because the order being appealed has expired.  There 
was no request to extend the order and there is no indication 
that Dane County has sought any additional order to which Sheila 
W. objects.2   
¶5 
All parties agree with the conclusion of the court of 
appeals that the issues presented in this case are moot.  Like 
the parties and the court of appeals, we also conclude that the 
issues presented are moot. 
¶6 
Sheila W. argues that this court should reach the 
merits 
of 
the 
issues 
presented 
despite 
the 
acknowledged 
mootness.  In past cases, this court has addressed moot issues 
when the issues presented are of "great public importance," or 
when "the question is capable and likely of repetition and yet 
                                                 
2 Counsel for Dane County observed at oral argument that no 
"movement" has been made for any additional order: 
But there is nothing in this record to suggest that 
this is an ongoing problem at this point.  For the 
last year, there has not been, to the best of my 
knowledge, any movement to subject [Sheila W.] to 
additional transfusions to which she objects, and to 
the best of my knowledge she survives.  
No. 
2012AP500   
 
4 
 
evades appellate review . . . ."  State ex rel. Angela M.W. v. 
Kruzicki, 209 Wis. 2d 112, 120 n.6, 561 N.W.2d 729 (1997).3   
¶7 
This case undoubtedly presents issues of great public 
importance.  Questions concerning when or if a minor may 
withdraw consent to life-saving medical treatment are inquiries 
"bristling with important social policy issues."  Id. at 134.  
Furthermore, 
it 
appears 
that 
orders 
appointing 
temporary 
guardians for the purpose of determining whether to consent to 
life-saving medical care are capable and likely of repetition 
and yet will evade appellate review.   
¶8 
In this instance, we deem it unwise to decide such 
substantial social policy issues with far-ranging implications 
based on a singular fact situation in a case that is moot.  In 
Eberhardy v. Circuit Court for Wood Cnty., 102 Wis. 2d 539, 307 
N.W.2d 881 (1981), this court was faced with a similar dilemma 
of whether to yield initially to the legislature on a social 
policy issue.  In that case the guardians of a mentally-impaired 
adult 
daughter 
sought 
court 
approval 
for 
her 
surgical 
sterilization.  Id. at 541-42.  The court concluded that because 
of 
the 
complexities 
of 
the 
public 
policy 
considerations 
involved, opportunity should be given to the legislature to 
                                                 
3 For additional discussion of mootness and its exceptions, 
see, e.g., State v. Schulpius, 2006 WI 1, 287 Wis. 2d 44, 707 
N.W.2d 495; Sauk Cnty. v. Aaron J.J., 2005 WI 162, 286 Wis. 2d 
376, 706 N.W.2d 659; State ex rel. Riesch v. Schwarz, 2005 WI 
11, 278 Wis. 2d 24, 692 N.W.2d 219; State v. Morford, 2004 WI 5, 
268 Wis. 2d 300, 674 N.W.2d 349; City of Racine v. J-T 
Enterprises of America, Inc., 64 Wis. 2d 691, 221 N.W.2d 869 
(1974). 
No. 
2012AP500   
 
5 
 
conduct hearings and undertake the necessary fact-finding 
studies that would result in measured public policy along with 
statutory guidelines.  Id. at 542.  The court explained: 
The legislature is far better able, by the hearing 
process, to consider a broad range of possible fact 
situations.  It can marshal informed persons to give 
an in-depth study to the entire problem and can secure 
the 
advice 
of 
experts . . . 
to 
explore 
the 
ramifications of the adoption of a general public 
policy . . . . 
Id. at 570-71.  
¶9 
For the same reasons enunciated in Eberhardy, we 
decline at this time to exercise the court's discretion to 
address the moot issues presented in this case.4  Accordingly, we 
affirm the court of appeals. 
By the Court.—The decision of the court of appeals is 
affirmed. 
 
 
 
 
 
                                                 
4 As 
the 
court 
stated 
in 
Eberhardy 
in 
yielding 
to 
legislative action, it should not be construed that "this court 
abrogates its own authority and jurisdiction to act on this 
subject at a future time if it becomes apparent that the 
legislature is unable or unwilling to act."  Eberhardy v. 
Circuit Court for Wood Cnty., 102 Wis. 2d 539, 578, 307 N.W.2d 
881 (1981).   
 
No.  2012AP500.dtp 
 
 
1 
 
 
¶10 DAVID T. PROSSER, J.   (concurring).  The Per 
Curiam opinion concludes that this case is moot.  It further 
concludes that, although the case raises issues of great public 
importance and presents a situation likely to repeat itself yet 
evade appellate review, the court should not proceed to exercise 
its discretion to take up issues that ought, if possible, to be 
decided by the legislature.  I strongly agree with this 
decision.  I write separately to supplement the explanation of 
why further court action at this time would be premature and 
undesirable. 
I 
¶11 In considering this case, the court is not fully 
apprised about the present status of Sheila W.  Thus, the case 
is being reviewed on facts that are more than a year old. 
¶12 In the early months of 2012, Sheila W. (Sheila), then 
15, was diagnosed with aplastic anemia, a life-threatening 
illness in which a person's immune system attacks the person's 
bone marrow, preventing the body from producing new blood cells.  
Sheila 
had 
received 
treatment 
for 
her 
condition 
at 
the 
University of Wisconsin Hospital in Madison, and she was taking 
immunosuppressant drugs without objection.  Sheila's doctors 
determined, however, that Sheila needed blood transfusions and 
that if she did not have them, her condition would become dire.  
Her red blood cell, white blood cell, and platelet counts were 
very low, and she was at risk of serious infection, spontaneous 
hemorrhage, and cardiac arrest.  Dr. Christian Capitini, a 
 
No.  2012AP500.dtp 
 
 
2 
 
pediatric hematologist who was Sheila's attending physician, 
informed Sheila that without blood transfusions, she would die. 
¶13 Sheila's 
parents 
refused 
to 
consent 
to 
blood 
transfusions.  Sheila and her family were Jehovah's Witnesses1 
who believed that God prohibits blood transfusions.  The parents 
indicated to their daughter that they believed she was mature 
enough to make her own decision to accept or refuse blood 
transfusions, and they informed her that if she decided to 
accept blood transfusions, they would support her decision.  
However, the parents would not personally consent. 
¶14 Sheila refused to consent to the transfusions, citing 
a Biblical passage from Acts 15:28 and 29.  She told Dr. 
Capitini 
that 
she 
"would 
rather 
die 
not 
receiving 
the 
transfusions than survive, but have the stigma of having 
received a transfusion."  She told Cheryl Bradley, a child 
protection worker for Dane County, that she would not consent to 
a blood transfusion under any circumstances, even in the face of 
death.  She told Dane County Circuit Judge William Foust that a 
blood transfusion would be "devastating to me mentally and 
physically" because it is "my body, my belief, my wishes."  She 
considered a blood transfusion equivalent to "rape."  
                                                 
1 According to the annual report of Jehovah's Witnesses, 
there 
were 
approximately 
7.8 
million 
active 
members, 
or 
"publishers," worldwide in 2012, with roughly 1.2 million 
members in the United States.  Watch Tower Bible and Tract 
Society of Pa., 2013 Yearbook of Jehovah's Witnesses, 178, 186, 
190 (2013). 
 
No.  2012AP500.dtp 
 
 
3 
 
¶15 On March 1, 2012, Dane County filed a petition for 
protection or services for Sheila under Wis. Stat. § 48.255 and 
a petition for temporary physical custody under Wis. Stat. 
§ 48.205.  The following day, the Dane County Circuit Court 
conducted a hearing at University Hospital.  After receiving 
testimony, the court sua sponte appointed a temporary guardian 
for Sheila under Wis. Stat. § 54.50.  The guardian was given 
authority to decide whether to consent to the recommended 
medical treatment.  The guardian consented, and an undetermined 
number of blood transfusions were administered to Sheila.  The 
court's guardianship order expired 60 days after March 2, 2012, 
and was not extended.  The expiration of the order is the 
principal reason this case is moot. 
II 
¶16 In this review, Sheila asks the court to disregard 
mootness and to recognize the "mature minor doctrine" as part of 
Wisconsin law.  Sheila describes the mature minor doctrine as an 
exception to the general rule requiring parents to give consent 
to medical treatment for their children.  Under the doctrine, 
older minors can be permitted to independently make medical 
treatment decisions involving their own care if they demonstrate 
"sufficient understanding and appreciation of the nature and 
consequences of treatment despite their chronological age."  Fay 
A. 
Rozovsky, 
Consent 
to 
Treatment: 
A 
Practical 
Guide, 
§ 5.01[B][3] (4th ed. 2012).  The court's recognition of the 
mature minor doctrine would presumably enable Sheila to refuse 
any future blood transfusions regardless of the consequences. 
 
No.  2012AP500.dtp 
 
 
4 
 
¶17 The parties acknowledge that states have come to 
different conclusions about the mature minor doctrine.  A number 
of states have adopted some form of the doctrine, but there is 
little consistency about how to determine when a minor is 
"mature" and the full extent of the decisions to which that 
"maturity" may apply. 
¶18 Several states have recognized the "rights" of mature 
minors by statute.  See, e.g., Arkansas (Ark. Code Ann. § 20-9-
602(7) (2012)); New Mexico (N.M. Stat. Ann. § 24-7A-6.1.C. 
(1997)); South Carolina (S.C. Code Ann. § 63-5-340 (2010)); and 
Virginia (Va. Code Ann. § 63.2-100.2. (2012)).  But care must be 
taken not to misread some of these statutes.  For instance, the 
South Carolina statute provides: 
 
Any minor who has reached the age of sixteen 
years may consent to any health services from a person 
authorized by law to render the particular health 
service for himself and the consent of no other person 
shall be necessary unless such involves an operation 
which shall be performed only if such is essential to 
the health or life of such child in the opinion of the 
performing physician and a consultant physician if one 
is available. 
S.C. Code Ann. § 63-5-340 (2010) (emphasis added).  It is not 
clear from this statute whether a minor who has reached the age 
of 16 years may refuse lifesaving services, especially if those 
services are authorized by a parent or by a court.  A provision 
of South Carolina's Death with Dignity (or Right to Die) Act, 
S.C. Code Ann. § 44-77-30 (2002), permits a person to adopt a 
written declaration that life-sustaining procedures may be 
withheld, but only if the person is 18 years of age or older.  
 
No.  2012AP500.dtp 
 
 
5 
 
Consequently, while South Carolina "recognizes" the rights of 
mature minors by statute, the statute is not as far-reaching as 
the doctrine that Sheila proposes here. 
¶19 By contrast, New Mexico's statute appears to be very 
far-reaching and to cover Sheila's 2012 circumstances.  The 
pertinent statute reads:   
Subject to the provisions of Subsection B of this 
section, 
if an unemancipated minor has capacity 
sufficient 
to 
understand 
the 
nature 
of 
that 
unemancipated minor's medical condition, the risks and 
benefits of treatment and the contemplated decision to 
withhold or withdraw life-sustaining treatment, that 
unemancipated 
minor shall have the authority to 
withhold or withdraw life-sustaining treatment. 
N.M. Stat. Ann. § 24-7A-6.1.C. (1997).  If this statute had been 
in effect last year in Wisconsin, Sheila would now likely be 
dead. 
¶20 There also are a number of court decisions that have 
adopted some form of the mature minor doctrine.  See, e.g., 
Kozup v. Georgetown Univ., 851 F.2d 437, 439 (D.C. Cir. 1988); 
People v. E.G., 549 N.E.2d 322, 325 (Ill. 1989); Younts v. St. 
Francis Hosp. & Sch. of Nursing, 469 P.2d 330, 338 (Kan. 1970); 
In re Swan, 569 A.2d 1202, 1205 (Me. 1990); In re Rena, 705 
N.E.2d 1155, 1157 (Mass. App. Ct. 1999); Bakker v. Welsh, 108 
N.W. 94, 96 (Mich. 1906); Gulf & Ship Island R.R. Co. v. 
Sullivan, 119 So. 501, 502 (Miss. 1928); Cardwell v. Bechtol, 
724 S.W.2d 739, 748-49 (Tenn. 1987); Belcher v. Charleston Area 
Med. Ctr., 422 S.E.2d 827, 837-38 (W. Va. 1992).  The substance 
of these decisions is not uniform.  To illustrate, the Tennessee 
Supreme Court adopted the so-called Rule of Sevens, which 
 
No.  2012AP500.dtp 
 
 
6 
 
provides that children under the age of 7 have no capacity to 
consent to medical treatment, children between the ages of 7 and 
14 have a rebuttable presumption of no capacity, and children 
between the ages of 14 and the age of majority possess a 
rebuttable presumption of capacity.  Cardwell, 724 S.W.2d at 
745. 
¶21 In 2009 the Supreme Court of Canada exhaustively 
considered the mature minor doctrine in a case similar to the 
one before us.  A.C. v. Manitoba, [2009] 2 S.C.R. 181 (Can.).  
In A.C., the statutory law in Manitoba recognized a mature 
minor's views with respect to her own health care but authorized 
the Director of Child and Family Services to seek treatment for 
a child whom the director believed did not understand or 
appreciate the consequences of the child's decision.  The 
subject of the case was admitted to a hospital when she was 14 
years, 10 months old, suffering from internal bleeding caused by 
Crohn's disease.  Id., para. 5.  She was a devout Jehovah's 
Witness, id.,  who previously had signed an advance medical 
directive containing her written instructions not to be given 
blood under any circumstances.  Id., para. 6.  Her doctor 
believed that internal bleeding created an imminent risk of 
death.  Id., para. 11.  Nevertheless, A.C. refused to consent to 
a blood transfusion.  Id., para. 7.   
¶22 A brief psychiatric assessment took place at the 
hospital on the night after the young woman's admission.  Id., 
para. 6.  The Director of Child and Family Services determined 
her to be a child in need of protection, and sought a treatment 
 
No.  2012AP500.dtp 
 
 
7 
 
order from the court under section 25(8) of the Manitoba Child 
and Family Services Act, under which the court may authorize 
treatment that it considers to be in the child's best interests.  
Id., paras. 8–9.  Section 25(9) of the Act presumes that the 
best interests of a child 16 or over will be most effectively 
promoted by allowing the child's views to be determinative, 
unless it can be shown that the child does not understand the 
decision or appreciate its consequences.  Id., para. 9.  Where 
the child is under 16, however, no such presumption exists.  See 
id.  As a result, the local court ordered that A.C. receive 
blood transfusions, concluding that "when a child is under 16 
years old, there are no legislated restrictions . . . on the 
court's ability to order medical treatment in the child's best 
interests."  Id., para. 12 (internal quotation marks omitted).  
A.C. and her parents appealed the order, arguing that the 
legislative scheme was unconstitutional because it unjustifiably 
infringed A.C.'s rights under the Manitoba statute and the 
Canadian Charter of Rights and Freedoms.  Id., para. 14.  The 
Court of Appeal upheld the constitutional validity of the 
challenged provisions as well as the treatment order.  See id., 
paras. 15–20. 
¶23 Writing for a majority of the Supreme Court, Justice 
Rosalie Abella made the following observations: 
 
The application of an objective "best interests" 
standard to infants and very young children is 
uncontroversial.  Mature adolescents, on the other 
hand, have strong claims to autonomy, but these claims 
exist in tension with a protective duty on the part of 
the state that is also justified. 
 
No.  2012AP500.dtp 
 
 
8 
 
 
. . . .  
 
In the vast majority of situations where the 
medical treatment of a minor is at issue, his or her 
life or health will not be gravely endangered by the 
outcome of any particular treatment decision. . . .  
 
Where a young person comes before the court under 
s. 25 of the Child and Family Services Act, on the 
other hand, it means that child protective services 
have concluded that medical treatment is necessary to 
protect his or her life or health, and either the 
child or the child's parents have refused to consent.  
In this very limited class of cases, it is the 
ineffability inherent in the concept of "maturity" 
that justifies the state's retaining an overarching 
power to determine whether allowing the child to 
exercise his or her autonomy in a given situation 
actually accords with his or her best interests.  The 
degree of scrutiny will inevitably be most intense in 
cases 
where 
a 
treatment 
decision 
is 
likely 
to 
seriously endanger a child's life or health. 
 
The more a court is satisfied that a child is 
capable of making a mature, independent decision on 
his or her own behalf, the greater the weight that 
will be given to his or her views when a court is 
exercising its discretion under s. 25(8). . . .  Such 
an approach clarifies that in the context of medical 
treatment, young people under 16 should be permitted 
to attempt to demonstrate that their views about a 
particular 
medical 
treatment 
decision 
reflect 
a 
sufficient degree of independence of thought and 
maturity. 
 . . . When applied to adolescents, therefore, 
the "best interests" standard must be interpreted in a 
way 
that 
reflects and addresses an adolescent's 
evolving capacities for autonomous decision making.  
It is not only an option for the court to treat the 
child's views as an increasingly determinative factor 
as 
his 
or 
her 
maturity 
increases, 
it 
is, 
by 
definition, in a child's best interests to respect and 
promote his or her autonomy to the extent that his or 
her maturity dictates. 
A.C., 2 S.C.R. 181, paras. 82, 85-88. 
 
No.  2012AP500.dtp 
 
 
9 
 
¶24 The authorities cited above, including the decision of 
the Supreme Court of Canada, reveal the seriousness that should 
be afforded to Sheila's position.  But her position may not 
represent the majority view in Wisconsin and it may not 
represent sound public policy.  Asking this court to enshrine 
Sheila's view into our law is asking the court to make 
profoundly important policy determinations about the rights of 
minors as well as the role of parents and the role of the state 
without statutory guidance.  It is asking this court to make up 
the law on its own initiative.  Courts need not and should not 
leap into controversies that may upset longstanding legal 
principles unless their involvement is unavoidable.  This 
court's involvement is not unavoidable today. 
III 
¶25 There are specific reasons why the court is correct in 
not acting now.   
¶26 First, unlike Canada and several states, Wisconsin has 
not codified a mature minor doctrine into its statutory law.  
However, Wisconsin does have a statute on advance directives to 
physicians, Wis. Stat. § 154.03(1) ("Any person of sound mind 
and 18 years of age or older may at any time voluntarily execute 
a declaration . . . authorizing the withholding or withdrawal of 
life-sustaining procedures or of feeding tubes"), and a statute 
on Power of Attorney for Health Care that specifically provides 
that "[a]n individual who is of sound mind and has attained age 
18 may voluntarily execute a power of attorney for health care."  
Wis. Stat. § 155.05(1) (emphasis added).  By incorporating the 
 
No.  2012AP500.dtp 
 
 
10 
 
adult age of 18 into these statutes, the legislature appears to 
have made a policy choice that is relevant to the present case. 
¶27 Counsel have not briefed the applicability, if any, of 
any provision of Wis. Stat. § 51.61.   
¶28 Second, the court is reviewing this case against the 
backdrop of State v. Neumann, 2013 WI 58, ___ Wis. 2d ___, ___ 
N.W.2d ___, in which the court upheld the convictions of Dale 
and Leilani Neumann for second-degree reckless homicide in the 
death of their 11-year-old daughter Kara.  Kara died from 
diabetic ketoacidosis resulting from untreated juvenile onset 
diabetes mellitus.  Id., ¶1.  Her parents were concerned about 
Kara's health and prayed for her recovery, but they never tried 
to secure medical treatment for her.  After Kara died, her 
parents were prosecuted for second-degree reckless homicide.  
Id. 
¶29 Although I disapproved of the parents' neglect, I 
dissented 
from 
their 
convictions 
under 
the 
second-degree 
reckless homicide statute because I thought the statutory scheme 
was "very difficult to understand and almost impossible to 
explain."  Id., ¶213 (Prosser, J., dissenting).  The statutory 
scheme 
presented 
notice 
issues 
to 
potential 
defendants, 
including the question of when a failure to act amounts to 
reckless conduct.  The court said the answer to when a failure 
to act amounts to reckless conduct is when the failure violates 
a "legal duty."  Id., ¶94. 
¶30 The majority in Neumann had no problem determining 
that the Neumanns violated a "legal duty" to provide medical 
 
No.  2012AP500.dtp 
 
 
11 
 
care to their daughter.  Against that background, what is the 
parental duty here?  Sheila's parents refused to consent to 
lifesaving blood transfusions for their daughter.  Would 
Sheila's parents have escaped criminal responsibility if Sheila 
had died from not receiving blood transfusions if the parents 
claimed that they had delegated medical decision-making to their 
daughter?  Stated differently, does a state's adoption of a 
mature minor doctrine relieve parents of whatever duty they have 
to provide medical care to their "mature" children?  These 
questions have not been briefed, and, in my view, the court is 
unprepared to answer them. 
¶31 Third, permitting a minor to refuse lifesaving medical 
treatment comes uncomfortably close to permitting a minor to 
commit suicide. 
¶32 Wisconsin law provides that, "[w]hoever with intent 
that another take his or her own life assists such person to 
commit suicide is guilty of a Class H felony."  Wis. Stat. 
§ 940.12 (emphasis added).  At first glance, this statute would 
not appear to be implicated in a situation where a minor is 
permitted to refuse blood transfusions.  In such a case, a 
potential defendant would not normally have the purpose that the 
minor commit suicide.  However, the phrase "with intent that" 
also means a defendant was aware that his or her conduct was 
practically certain to cause (the minor) to commit suicide. 
¶33 What is suicide?  On this point, Sheila's doctors did 
not believe that she had a terminal illness.  Assuming that she 
is still alive, her doctors were correct.  But Sheila's 
 
No.  2012AP500.dtp 
 
 
12 
 
attending physician predicted that she would die without blood 
transfusions.  There was no alternative treatment to preserve 
her life.  Refusing to agree to the only known treatment to save 
one's life is suicidal unless a person's condition is terminal.2  
Facilitating 
suicidal 
conduct 
in 
these 
circumstances 
is 
practically certain to cause the person's death.3  Here, the 
"person" is a minor. 
¶34 The mature minor doctrine anticipates that the state 
will take steps to assure that a minor has the maturity and 
understanding to knowingly, intelligently, and voluntarily make 
the decision whether to act to preserve her own life.  This is 
likely to put courts in the unenviable position of either 
prohibiting or permitting a minor's suicidal conduct. 
¶35 Courts are often obligated to enforce law that they 
may not approve.  They are not obligated to create law that they 
do not approve.  To my mind, it is not sound public policy to 
force courts to give their imprimatur to a minor's commitment to 
martyrdom.   
                                                 
2 See Cruzan v. Dir., Mo. Dep't of Health, 497 U.S. 261, 293 
(1990) (Scalia, J., concurring) ("American law has always 
accorded the State the power to prevent, by force if necessary, 
suicide——including suicide by refusing to take appropriate 
measures necessary to preserve one's life").   
3 Cf. 
Lenz 
v. 
L.E. 
Phillips 
Career 
Dev. 
Ctr., 
167 
Wis. 2d 53, 70, 482 N.W.2d 60 (1992) ("It is difficult not to 
view the withdrawal of artificial feeding as inducing death 
through starvation and dehydration."). 
 
No.  2012AP500.dtp 
 
 
13 
 
¶36 Finally, Sheila told her attending physician that she 
would rather die than endure the "stigma of having received a 
transfusion." 
¶37 According to the American Red Cross, 30 million blood 
components are transfused each year in the United States.  Am. 
Red 
Cross, 
Blood 
Facts 
and 
Statistics, 
http://www.redcrossblood.org./learn-about-blood/blood-facts-and-
statistics (last visited June 27, 2013).  These blood components 
are received by approximately 5 million patients from more than 
9 million donors.  Id.  There is little stigma attached to blood 
transfusions among the population at large, although there is 
often concern about the safety of the blood supply. 
¶38 Jehovah's Witnesses are one of the most notable 
exceptions.  They consider the issue of blood transfusions to be 
"a religious issue rather than a medical one.  Both the Old and 
New Testaments clearly command us to abstain from blood."  Watch 
Tower Bible and Tract Society of Pa., Why Don't You Accept Blood 
Transfusions?, 
http://www.jw.org/en/jehovahs-
witnesses/faq/jehovahs-witnesses-why-no-blood-transfusions/ 
(citing Genesis 9:4; Leviticus 17:10; Deuteronomy 12:23; Acts 
15:28, 29) (last visited June 27, 2013).  Some Jehovah's 
Witnesses have been accused of disfellowshipping, even shunning, 
members who consent to blood transfusions.  See Osamu Muramoto, 
Bioethical aspects of the recent changes in the policy of 
refusal of blood by Jehovah's Witnesses, Brit. Med. J., Jan. 6, 
2001 at 37-39.  The court is not in a position to evaluate these 
accusations on the evidence before us.  However, the existence 
 
No.  2012AP500.dtp 
 
 
14 
 
of these accusations inevitably raises questions about whether a 
minor's decision to refuse blood transfusions——at the risk of 
her own death——is truly a voluntary decision when the minor is a 
Jehovah's Witness.   
¶39 The issues raised in this writing will be no easier 
for the legislature than for this court.  But the court ought to 
defer to the principal lawmaking branch of government before it 
tries to make policy on its own initiative. 
 
¶40 For the foregoing reasons, I respectfully concur. 
 
 
No.  12AP500.mjg 
 
1 
 
 
¶41 MICHAEL J. GABLEMAN, J.   (dissenting).  Two important 
issues are presented in this case: (1) should Wisconsin 
recognize the mature minor doctrine, which permits those under 
18 years of age to refuse life-saving medical care under some 
circumstances?; and (2) does a minor have a due-process right to 
refuse medical treatment?  Instead of answering them, the court 
washes its hands of the matter and declares the case moot.  As 
this court has a responsibility to decide matters of great 
public importance that are likely to recur but evade appellate 
review, I dissent from the decision to dismiss this appeal.   
¶42 A brief recitation of the facts and procedural history 
is necessary to demonstrate the absurdity of the majority's 
refusal to decide this case.  In February 2012, 15-year-old 
Sheila W. was diagnosed with aplastic anemia, a condition that 
prevents her bone marrow from producing blood cells.  If left 
untreated, the condition is fatal.  Sheila was admitted to the 
hospital on February 25, 2012 and given antibody treatments.  
After three days of treatment, however, her blood platelet count 
remained at a critically low level, putting her at risk of 
spontaneous 
hemorrhage, 
cardiac 
arrest, 
and 
respiratory 
distress.  Sheila's treating physician thus recommended that she 
undergo blood transfusions.  Without these transfusions, her 
doctor stated that she would die.  
¶43 Sheila 
and 
her 
parents, 
though, 
are 
Jehovah's 
Witnesses, who believe that the Bible requires them to "abstain 
from blood."  Receiving a blood transfusion would violate this 
belief, and Sheila described it as tantamount to "rape."  Her 
No.  12AP500.mjg 
 
2 
 
parents, citing deference to their daughter's decision, stated 
they would not force a transfusion upon her, even knowing she 
would die.   
¶44 Due to the high risk of imminent death, Dane County 
took emergency custody of Sheila on February 29.  The County 
then filed a petition for protective services the next day, 
seeking temporary physical custody of Sheila to administer the 
blood transfusions.  See Wis. Stat. § 48.13(10).  On Friday, 
March 2, the circuit court held a hearing in the hospital.  The 
court found that Sheila's parents were "seriously endanger[ing]" 
her health by refusing to consent to the transfusions.  But 
instead of granting the petition for temporary physical custody, 
the court appointed a temporary guardian pursuant to Wis. Stat. 
§ 54.50(1).  The order gave the guardian authority to "[d]ecide 
whether to consent to medical treatment."  Sheila's motion to 
stay the order pending an appeal was denied by the circuit 
court.  Sheila's appointed guardian consented to the blood 
transfusions, the first of which was successfully performed 
later that day.  The following Monday, the day before Sheila was 
scheduled for another transfusion, she filed a notice of appeal.  
The court of appeals also denied Sheila's motion to stay the 
transfusions pending an appeal, stating that "the irreparable 
harm Sheila would suffer if forced to undergo continued blood 
transfusions against her religious beliefs is outweighed by the 
irreparable harm to the public interest in preserving life and 
protecting minors that would occur if Sheila were to die while 
the appeal is pending."  However, the court did state that "it 
No.  12AP500.mjg 
 
3 
 
would be open to a motion to expedite this appeal to minimize 
the length of time Sheila receives transfusions, in the event 
that the guardianship order is ultimately reversed by this court 
or the Wisconsin Supreme Court."     
¶45 By the time the case was fully briefed before the 
court of appeals, the temporary guardianship order had expired.  
While conceding that her appeal was thus moot because she no 
longer needed the transfusions, Sheila argued that her case 
nonetheless fell under one of the exceptions to the general rule 
that a court does not decide moot issues.  We have stated that a 
court may address moot issues when: the issue has great public 
importance, 
a 
statute's 
constitutionality 
is 
involved, 
a 
decision is needed to guide the trial courts, or the issue is 
likely to repeat yet evade review because the situation at hand 
is one that typically is resolved before completion of the 
appellate process.  Sauk Cnty. v. Aaron J.J., 2005 WI 162, ¶3 
n.1, 286 Wis. 2d 376, 706 N.W.2d 659 (per curiam).  In a two-
page summary order, the court of appeals concluded that Sheila's 
appeal did not satisfy any of the exceptions to mootness.     
¶46 Sheila filed a petition for review on November 27, 
2012.  In its response to the petition, Dane County argued that 
the court of appeals correctly dismissed the case as moot.  On 
January 15, 2013, we granted Sheila's petition for review.  On 
February 7, we assigned the case for oral argument.  Each party 
filed briefs.  Oral argument was held April 11.   
¶47 The subject of mootness was only glancingly touched 
upon at oral argument.  In her opening statement to the court, 
No.  12AP500.mjg 
 
4 
 
Dane County's attorney said, "Dane County asks that you dismiss 
this appeal as moot.  The County believes that's the most 
appropriate outcome in this case, one that leaves the delicate 
social balancing that we have been talking about among complex 
and competing policy interests to the legislature."  No follow-
up questions on mootness were asked.  In fact, the issue of 
mootness received only passing, perfunctory references during 
the 70-minute oral argument.  No member of this court asked 
Sheila's attorney for her position on mootness, and she did not 
offer it.      
¶48 Based on this court's actions since granting the 
petition for review in January, Sheila W. is entitled to feel 
blindsided by today's decision to dismiss her appeal as moot.  
And upon reading the per curiam issued by four members of this 
court, her shock is likely to turn to confusion.  The per curiam 
assures us that "[t]his case undoubtedly presents issues of 
great public importance. . . .  Furthermore, it appears that 
orders appointing temporary guardians for the purpose of 
determining whether to consent to life-saving medical care are 
capable and likely [to repeat] and yet will evade appellate 
review."  Per Curiam, ¶7.  In other words, according even to the 
per curiam opinion, Sheila meets two of the exceptions to 
mootness.1        
¶49 Despite these conclusions, the per curiam holds: "In 
this instance, we deem it unwise to decide such substantial 
                                                 
1 I would add that this case also satisfies a third 
exception to mootness: a decision is needed to guide the trial 
courts.   
No.  12AP500.mjg 
 
5 
 
social policy issues with far-ranging implications based on a 
singular fact situation in a case that is moot."  Per Curiam, 
¶8.  I do not understand what the majority means by this.  
"Singular," as the per curiam uses the word, would seem to mean 
"unique," "beyond what is ordinary," or "strange or unusual."  
The American Heritage Dictionary of the English Language 1636 
(5th ed. 2011).  I fail to see why the facts in this case make 
it a bad candidate to evaluate whether Wisconsin should adopt 
the common law mature minor doctrine or decide the scope of a 
minor's due-process rights.  The mature minor doctrine asks when 
and whether someone under the age of 18 should be permitted to 
refuse medical care.  See e.g., Illinois v. E.G., 549 N.E.2d 
322, 327-28 (Ill. 1989).  This case presents about as clear an 
opportunity to address that question as can be imagined.  
Furthermore, why does a "singular fact situation" make a 
particular case unworthy of our review?  Every case to some 
extent has a "unique" set of facts, and many have "strange or 
unusual facts."  To say that a case of "great public importance" 
cannot be resolved because the particular facts are "singular" 
is no answer at all.2    
                                                 
2 Justice Prosser's concurrence attempts to provide the 
rationale lacking from the per curiam.  Much of the concurrence, 
however, reads like a dissent from a decision to adopt the 
mature minor doctrine, which this court has not done.  See 
concurrence, ¶¶24, 31, 34, 35.  To be clear, this dissent does 
not take a position on whether the court should adopt the mature 
minor doctrine or whether minors have a due-process right to 
refuse medical treatment because a majority of this court 
inexplicably does not want to decide those issues.      
No.  12AP500.mjg 
 
6 
 
¶50 Paradoxically, the court uses Eberhardy v. Circuit 
Court for Wood Cnty., 102 Wis. 2d 539, 307 N.W.2d 881 (1981) as 
its fig leaf.  Eberhardy presented the question of "whether the 
circuit court has jurisdiction to authorize the duly appointed 
guardians of an adult mentally retarded female ward to give 
their consent to surgical procedures which will result in the 
permanent sterilization of the ward when such sterilization is 
for contraceptive and therapeutic purposes," and if the circuit 
court had such jurisdiction, whether it was "appropriate for the 
court to exercise it for this purpose."  Id. at 541-42.  We held 
that although the circuit courts had jurisdiction over a 
guardian's petition seeking sterilization of an incompetent 
ward, they were not permitted to exercise that jurisdiction 
until the legislature provided clear guidelines in the area.  
Id. at 578-79.  In doing so we stressed the "irreversible" 
nature of sterilization.  Id. at 567, 568, 572, 575, 577, 585, 
592.  However, in a passage that should give the majority pause, 
we stated: "The inevitability of the consequences of not acting 
judicially in this case does not approach the degree that might 
force a choice if the question were one of invoking state power 
to order treatment for one who would die without it."  Id. at 
575.  Thus by its own terms Eberhardy does not dictate the 
result reached by the court today.  In fact, it counsels just 
the opposite.     
¶51 Equally 
important, 
Eberhardy 
shows 
that 
the 
legislature does not always act quickly in response to this 
court's prodding.  The only Wisconsin statute to address the 
No.  12AP500.mjg 
 
7 
 
sterilization 
of 
incompetents, 
Wis. 
Stat. 
§ 54.25(2)(c)e., 
provides that if an individual is declared incompetent and a 
guardian appointed, the circuit court may "declare that the 
individual has incapacity . . . to consent to sterilization, if 
the 
court 
finds 
that 
the 
individual 
is 
incapable 
of 
understanding the nature, risk, and benefits of sterilization, 
after the nature, risk, and benefits have been presented in a 
form that the individual is most likely to understand."  Yet it 
was not until 25 years after Eberhardy that this statute was 
enacted!  2005 Wis. Act 387, § 100 (effective May 25, 2006).  As 
Justice Callow pointed out in his Eberhardy dissent, "[a]part 
from 
any 
aversion 
legislators 
may 
have 
to 
addressing 
a 
controversial question, there is the added practical problem of 
the press of legislative business.  The thousands of problems 
presented to the legislature tax its ability to respond 
thoughtfully to the multiple problems of society."  102 Wis. 2d 
at 605.  As the history following Eberhardy reveals, the Sheila 
W.s of this state may have to wait a long time before the 
legislators on white horses arrive.  In the meantime, the actual 
problem of what to do with minors who refuse life-saving 
treatment will remain unresolved.       
¶52 Additionally, 
the 
question 
of 
the 
mature 
minor 
doctrine is not just an abstract academic debate.  The decision 
over whether this state should adopt such a doctrine will 
literally have life or death consequences for people such as 
Sheila W.  Currently, the circuit courts have no standard to 
apply when presented with a minor who refuses life-saving 
No.  12AP500.mjg 
 
8 
 
medical care.  Frighteningly, this raises the specter that a 
child's life could depend on which judge within a county is 
assigned the case.3  Unfortunately, four members of this court 
refuse to offer any guidance to circuit court judges who must 
actually adjudicate these difficult situations.       
¶53 The case is just as moot now as it was when we granted 
the petition for review back on January 15.  If the court did 
not want to decide the issues presented in this case, it should 
not have granted the petition for review, ordered briefing, and 
then held oral argument.  What function is served when a law-
developing court takes a summary order declaring a case moot and 
affirms it with a summary order declaring a case moot?  Life is 
about hard choices, particularly for members of a state high 
court.  Unfortunately, today the only thing the parties receive 
for their time and trouble before this court is abdication 
dressed as modesty. 
¶54 I am authorized to state that Justices PATIENCE DRAKE 
ROGGENSACK and ANNETTE KINGSLAND ZIEGLER join this dissent.   
                                                 
3 The concurrence states that we should not adopt the mature 
minor doctrine because it would put courts "in the unenviable 
position of either prohibiting or permitting a minor's suicidal 
conduct."  Concurrence, ¶34.  Aside from inappropriately 
assuming that this court would adopt the doctrine if the case 
were not moot, the concurrence's statement is ironic because the 
decision of this court to not answer the questions presented is 
what will put circuit courts in the position of making ad hoc 
life or death decisions.  If Sheila were to relapse and require 
blood transfusions again before her eighteenth birthday, how 
would the members of the majority advise a court to handle the 
matter?  Would it have been wrong for the circuit court judge in 
this case to allow Sheila to die?  Inaction by the majority will 
lead to the patchwork approach the concurring Justice is 
attempting to avoid.   
No.  12AP500.mjg 
 
 
 
1