Opinion ID: 2113797
Heading Depth: 1
Heading Rank: 2

Heading: insufficient evidence of wanton or reckless conduct to go to a jury

Text: For purposes of the present point, we assume there was sufficient evidence to entitle the jury to find a live birth, in some sense of that term, and subsequent death, as required for conviction of manslaughter under the judge's charge. But what acts of Dr. Edelin could be taken into account in deciding his guilt or innocence of manslaughter? Although the judge's charge is not crystal clear on the matter, we read his charge as meaning, and certainly capable of being understood to mean, that only acts of Dr. Edelin after the birth could constitute the conduct required for conviction of the crime. Thus: caused the death of a person who had been alive outside the body of his or her mother, caused the death of a person, once that person became such. As the defense has argued, these phrases are cast in the past perfect. The starting point of the duty owed by the defendant under the manslaughter statute was thus set at the stage after delivery from the mother, and attention centers upon the heartbeat test evidence. Taking the evidence on this point in a light favorable to the Commonwealth (see Commonwealth v. Kelley, 370 Mass. 147, 149-150 [1976]; G.L.c. 278, § 11), we find nothing of substance in it to permit a submission to a jury as to criminal recklessness or the like. Although the fetus may have been alive in the very narrow sense that there was some postnatal gasping of air as revealed by microscopic analysis of preserved lung tissue long after the event, nothing of the sort was observable by Dr. Edelin as he carried out the operation. To all appearances, the fetus was dead. Dr. Edelin found no heartbeat and saw no other indication that he had a live being in his hands. If we give the prosecution the benefit of a remark by a defense witness that a test for heartbeat, to be absolutely conclusive, should extend longer than the few seconds testified to by Dr. Edelin, we have to note  besides the fact that there was no evidence as to any standard practice in this regard  that the witness did not say, nor could he say plausibly, that to test for the short period would be wanton or reckless behavior in any and all circumstances of a delivery. Here Dr. Gimenez, an eyewitness, joins in Dr. Edelin's observation. Dr. Gimenez testified: The baby [ sic ] was dead; it had no signs of life, such as breathing or movement. Dr. Gimenez had no criticism of the defendant on the score of his postnatal conduct. The Commonwealth tries to avoid the evident result by contending that the judge's charge should be read so as to allow consideration of Dr. Edelin's conduct during the prenatal stage. As already noted, we do not agree with that attempted interpretation. [20] In all events, such an interpretation would go counter to the law by which Dr. Edelin is to be judged, because, as we shall indicate, (i) it is very doubtful whether the manslaughter statute spoke to prenatal conduct, and (ii) if it purported to do so, it would be displaced pro tanto for purposes of the present case by the constitutional doctrine of Wade-Bolton. But the further answer is (iii) that Dr. Edelin's conduct from start to finish, both prenatal and postnatal, did not provide a basis for submission to a jury of the issue of recklessness or the like. Manslaughter assumes that the victim was a live and independent person. This is well understood, [21] and the judge so charged. Destruction of a fetus in utero is not a manslaughter. The further question was debated at common law [22] whether manslaughter might rest on a defendant's injuring a fetus in utero, where the fetus was later born alive, and then died of the injury without further guilty intervention by the defendant. In this Commonwealth, Holmes, J., seems to intimate a preference for the view that the prenatal acts could not ground a manslaughter despite the later live birth and death. Dietrich v. Northampton, 138 Mass. 14, 15, 17 (1884). (Common sense, besides common law, tended to support this position, for if a contrary rule were adopted, a putative defendant might be encouraged to make sure he extinguished the fetus while still in utero.) The effect, be it noted, was not to let the defendant off, but to subject him to the typical criminal abortion statute. See note 5 supra; Dietrich v. Northampton, supra at 17. Cf. Keeler v. Superior Court of Amador County, 2 Cal.3d 619, 635-636 (1970). [23] But if acts of a defendant during the prenatal period could ever be availed of in obtaining a conviction of manslaughter, that was a legal impossibility in the circumstances of this case after the Wade-Bolton decisions. (Thus our reading of the judge's charge is actually required to keep it within constitutional bounds.) Under Wade-Bolton, the State's regulation of abortions after viability to promote its interest in the potentiality of human life is expected to be expressed in tailored legislation. See Wade, 410 U.S. at 164-165. The detail that may be involved, representing an adjustment and accommodation of many considerations, is exemplified by the comprehensive legislation in fact adopted by our Legislature in August, 1974. [24] The manslaughter statute is flat and contains no such detail, and it would be not only incongruous but, we think, unconstitutional to attempt to bring it to bear on a physician as he went about the predelivery process of performing an abortion. After Wade-Bolton, even if not before, the manslaughter statute could take hold only after a live birth and only with respect to acts of the physician in the postnatal period. If the manslaughter statute conceivably could be utilized to control and punish a physician's conduct in the prenatal period, then the judge would be bound to say just how the statute should be applied consistently with Wade-Bolton. [25] The most obvious of the several matters calling for guidance by the trial judge would be a definition or description of viability marking the stage at which a physician would begin to owe a duty to the potentiality of human life inherent in the fetus. [26] On this point, as our digest of the judge's charge indicates, the instructions were uninstructive and left a wide-open option to the members of the jury. [27] However, that omission from the charge does not embarrass a decision to reverse and acquit because, on any view of viability tenable under Wade-Bolton, there was no sufficient showing of recklessness in Dr. Edelin's prenatal conduct  any more than in his postnatal conduct [28]  to permit reference of the question to a jury. His quo animo turned on whether he believed in good faith that the fetus was not viable at the time of the operation and was not palpably unreasonable in this belief  a combination of an internal and an external standard of criminality. See Commonwealth v. Welansky, 316 Mass. at 398-399, referring to Commonwealth v. Pierce, 138 Mass. 165 (1884). Of course manslaughter could not be supported by proof merely of a mistake of judgment, even if that was the result of negligence or gross negligence. The record shows that Dr. Edelin, as Chief Resident in OBS/GYN at Boston City Hospital, was well aware of the Wade-Bolton decisions and accordingly believed (correctly) that abortion was not automatically excluded at the stage of viability  that was for the Legislature to decide. He was concerned about viability, however, because it affected medical judgments and because he had a personal scruple against aborting a viable fetus. Again considering the evidence in a light favorable to the Commonwealth, there is nothing to impeach the defendant's good faith judgment that the particular fetus was nonviable, and nothing to suggest that that belief was grievously unreasonable by medical standards. [29] An independent judgment would be required of Dr. Edelin as surgeon in the case, and his independent estimate of twenty to twenty-two weeks of gestation was consistent with the double-checked estimate of the experienced chief of clinic. The bona fides of Dr. Edelin's estimate is perhaps reinforced by the fact that he used a relatively small uterine incision. We find nothing in the course of the operation which might have alerted him to the probability that he had been mistaken in his estimate. It is not shown that he was mistaken in fact. Prosecution and defense experts divided on whether the fetus was viable, but a trier's belief in one set of experts would not begin to show that Dr. Edelin's judgment the other way was reckless. All the testimony bears comparison with the indication in Wade about a twenty-eight to twenty-four weeks gestational age in relation to viability. It is to be borne in mind, also, that no witness was prepared to state that this fetus had more than the remotest possibility of meaningful survival. If we accept, as we think we must, that there was nothing to show Dr. Edelin believed the fetus to be viable, or was flagrantly mistaken in believing it to be nonviable, then even a three to five minute wait after detachment of the placenta would not count as recklessness because Dr. Edelin would think it indifferent to the possibility of meaningful survival. But to follow the operation more closely: The criticisms by Commonwealth witnesses of the protocol of commencing the hysterotomy with detachment of the placenta, [30] and of fixing the size of the particular uterine incision, were in the area of debate and, far from showing a criminal intent, did not reflect seriously on Dr. Edelin. Dr. Gimenez's testimony is fairly reconcilable with Dr. Edelin's: the pause Dr. Gimenez spoke of may well have been the interval of the delay in delivering the fetus that was due to the rupture of the amniotic sac. [31] However that may be, criminal recklessness is not in the picture if one starts with an understanding of Dr. Edelin's belief and judgment as to viability. If any doubt remains that there was no case for the jury on the question of recklessness, two special factors in the present situation should be considered. First, we deal here with the professional judgments of a qualified physician acting under stress at the operating table. The Supreme Court has cautioned in the abortion cases against the undue trammeling of judgments of the individual attending physician. In Bolton the Supreme Court struck down a statutory scheme for advance review of the attending physician's judgment by a panel of other physicians who would be conscious of the need to preserve the independence of the individual physician. (See Bolton, 410 U.S. at 195-200.) In the present case we have an attempted post hoc review of the attending physician's judgments through a battle of experts before a lay jury with a threat of criminal conviction and professional disgrace. Second, we deal here with the constitutional right of privacy of the patient and the correlative constitutional right of the physician  rights to which the Supreme Court has assigned very high value. There should be caution and circumspection in the interpretation and application of a criminal statute which, as employed here, must necessarily trench on professional practice and constitutional freedoms. This implies a wariness in assessing the strength of a criminal case made against a physician before it is held that there is enough evidence to submit to a jury. [32] III. ADDITIONAL VIEWS OF THREE JUSTICES A. Insufficient Evidence of Live Birth to Go to a Jury. Whether Dr. Edelin was reckless or wanton in dealing with the fetus is a question of what he believed and how he exercised judgment. There is a further and different question, whether in fact the fetus was born alive outside the mother's body. Under the judge's charge, there could be no subject of manslaughter unless and until the fetus was live born. The charge on this point might be accepted as framing the law of the case even if it were erroneous (see Commonwealth v. Graves, 363 Mass. 863, 868 [1973], and cases cited; Commonwealth v. Richards, 363 Mass. 299, 307 [1973]), but it is quite plain that the charge was correct. [33] The Commonwealth's original submission that the manslaughter statute should be read to cover the destruction in utero of a detached fetus, amounted merely to a misguided attempt, despite Wade-Bolton, to reconstitute the old criminal abortion statute under the guise of manslaughter. Without repeating the evidence on the question of live birth, we may note that the eyewitness testimony of Dr. Gimenez (confirming Dr. Edelin's testimony) was that the fetus was delivered dead. The only evidence suggestive of postnatal life came from examination of the preserved lungs. Gross examination of the lungs by the medical examiner indicated still birth, not live birth, and it was only on microscopic examination of the tissue that any hypothesis of breathing could arise. But the breathing, assuming there was any, must be shown to have occurred outside the mother; support for this could be found in the testimony of Dr. Ward, but that was rather equivocal. [34] If full marks should nevertheless be given Dr. Ward's testimony, that is, if it be assumed that it provided enough to entitle a jury to conclude beyond a reasonable doubt that some kind of breathing did occur after the fetus was delivered from the uterus  an assumption that appears doubtful indeed  then the question must be faced whether the breathing, such as it could have been, demonstrated postnatal life as required for conviction under the manslaughter statute. Postnatal life could be variously defined for the purpose, at one end of the spectrum as a capacity of the fetus, when delivered, to sustain existence for an indefinite period without artificial aid, and at the other end as a showing of any sign of activity such as a single gasp of air not observed or observable by the eye at the time, and established, if at all, by later microscopic analysis. The jury needed a standard to go by. But the trial judge did not provide a standard. [35] This might leave the case, with respect to the present point, in a condition where a new trial would be justified, but not acquittal. Here, however, we are able to say with confidence that on no acceptable standard was there proof sufficient to go to a jury. The defense had offered a proposed instruction drawing upon the definition of liveborn infant as formulated and published by the Committee on Terminology of the American College of Obstetricians and Gynecologists: LIVEBORN INFANT. Liveborn infant is a fetus, irrespective of its gestational age, that after complete expulsion or extraction from the mother, shows evidence of life  that is, heartbeats or respirations. Heartbeats are to be distinguished from several transient cardiac contractions; respirations are to be distinguished from fleeting respiratory efforts or gasps.... [36] This suggested standard, which required a minimal demonstration of independent existence beyond fleeting respiratory efforts or gasps, was less exacting of proof and therefore more favorable from the Commonwealth's viewpoint than the standard that has been applied in practice around the country in manslaughter cases involving newborns. [37] It commended itself by its relative objectivity, practicality, and moderation. By this standard (as by any variant that might be considered acceptable) the Commonwealth failed in its proof. [38] B. Prejudicial Shift from the Accusation as Specified by the Commonwealth to the Crime as Defined in the Judge's Instructions. There were discrepancies between (i) the indictment as particularized by the Commonwealth in its response to the request for particulars and (ii) the ingredients of the crime of manslaughter as the judge described them in his instructions to the jury. The indictment as particularized asserted that the fetus died either while it was in utero or when it was partially removed; under the judge's charge, either assertion, if proved, would be incompatible with manslaughter, for conviction depended on a live birth after delivery free of the mother. Further, the indictment as particularized asserted that the homicidal act was the deliberate pause in utero immediately following the detachment of the placenta; the judge's charge confined the jury to postnatal conduct (as the defense interprets the charge) or at least allowed the jury to consider postnatal conduct as part of the basis of conviction (as the prosecution interprets the charge). The bill of particulars had the effect of restricting the case that the Commonwealth was entitled to prove. [T]he specification affected the indictment and restricted the proof to the matters specified. Commonwealth v. American News Co., 333 Mass. 74, 77 (1955), and cases cited. It was open to the Commonwealth within reasonable limits of circumstance and time to amend its bill. See G.L.c. 277, § 40. It did not do so. This was despite the repeated warnings sounded by the defense that on the particulars furnished there was no manslaughter. Hence it is appropriate that the Commonwealth should be held to the ground it selected. The Commonwealth's proof, as restricted by the particulars, could not support conviction of the offense having the elements described by the judge in his instructions to the jury. Conversely, conviction must be taken to have rested on elements forming no part of the accusation as particularized. The offense must not only be proved as charged, but it must be charged as proved. Commonwealth v. Albert, 307 Mass. 239, 244 (1940), quoting from Commonwealth v. Blood, 4 Gray 31, 33 (1855). The upshot is that the defendant in the extraordinary circumstances of this case was entitled to acquittal. Commonwealth v. American News Co ., and Commonwealth v. Albert, both supra. See DeJonge v. Oregon, 299 U.S. 353, 362 (1937); In re Ruffalo, 390 U.S. 544, 550-552 (1968). (Whether, after acquittal on such a ground, the defendant might be reindicted, raises a question of double jeopardy that would take us far afield.) The policy of the statute on variance, G.L.c. 277, § 35, [39] tends to support acquittal in the present case. It says that a defendant shall not be acquitted on the ground of variance between the allegations and the proof, but this is conditioned on the essential elements of the crime being correctly stated. That was not the case here. The statute indicates, further, that even when the condition is met, acquittal is called for where the defendant was thereby prejudiced [i.e., by the variance] in his defence. As will be indicated below, that was the case here. It has been suggested that the particulars in the present case should be taken to have been informally amended to correspond more or less to the definition of the crime as finally given in the instructions, because the prosecution let it be known early on, by the time of the opening of trial, that it intended to attempt to prove breathing. But especially in the face of the particulars furnished that the homicidal act  the pause  occurred just following detachment of the placenta, this slipshod prosecution notice could well be understood to refer to proof of intrauterine respiratory activity bearing on viability, not to proof of a live birth outside the mother. Quite apart from this, however, the notice did not provide any warning that the prosecution was shifting ground from the claimed homicidal pause in utero to a supposed homicidal act or omission after birth clear of the mother. A switchover such as occurred here may be thought inherently prejudicial (as § 35 indeed suggests). But if there must be a demonstration of probable prejudice, the defense has shown it sufficiently. The defense puts an example of prejudice through confusion of the target. As noted earlier (note 31 supra ), the defense attacked Dr. Gimenez's credibility as a means of challenging his testimony (which stood alone) regarding the three to five minute wait. But the attack naturally tended also to discredit Dr. Gimenez's further testimony, as an eyewitness, that the fetus was dead at delivery. Yet that testimony, if believed, would destroy the Commonwealth's case, assuming the judge's instructions to the jury. This is an example of how the switchover could unfairly confound the defense. In another aspect, prejudice is shown. During the long course of the case (twenty-eight trial days) a great welter of testimony was admitted, over repeated objections, which had the effect of drenching the jury with the prosecution's theory of the case  that the fetus became a person at detachment of the placenta and was then destroyed by the surgeon's deliberate pause. Commonwealth experts expounded medical doctrine, largely of a definitional character, tending in one way or another to support that hypothesis: for example, that there was personhood when, after separation from the placenta, the fetus could maintain itself for any length of time on its own systems; that a fetus was to be considered viable if it was possible to project that, were it delivered at that moment, it would have any chance to survive for even an instant; that abortion was a procedure confined to the first twenty weeks of pregnancy; that abortion was related only to termination of pregnancy, and, notwithstanding any right of a woman in that regard, the physician was duty bound at all times to preserve the fetus. It is true that the judge indicated, both during the trial and in his charge, that testimony of this kind was being received in order to orient the jury to the witness's professional manner of thought or speaking, and was not to be taken as laying down the controlling legal precepts. The first trouble with regarding this as a corrective is that there was no attempt during trial to state the critical divergence of the definitional propositions from their proper legal counterparts. An attempt of this sort was made in the final instructions but the judge's remarks (i) were very brief in relation to the voluminous and accumulative testimony, (ii) did not point out wherein the testimony differed from the proper legal norms, and (iii) left important concepts empty of definition so that the received testimony would rush in to fill the spaces, since nothing else was being supplied. This is strikingly true of viability which was not only left in substance undefined by the judge, but was, according to him, to be availed of by the jury if ... you determine that the ... [term has] any applicability. There is, then, a strong probability of prejudice in that, notwithstanding the switchover, the jury may have convicted Dr. Edelin on the basis of the Commonwealth's erroneous view of the case. [40]