Opinion ID: 795353
Heading Depth: 4
Heading Rank: 1

Heading: The Right to Medical Information

Text: 21 While the contours of prisoners' rights will depend upon the requirements of prison administration and prison life, the Supreme Court has told us that inmates do not abandon their constitutional rights at the prison door. E.g., Turner v. Safley, 482 U.S. 78, 84, 107 S.Ct. 2254, 96 L.Ed.2d 64 (1987) (prisoners retain the right to petition the government for the redress of grievances, the right to protection against invidious racial discrimination, and the right to due process). And as the Supreme Court stated in Cruzan v. Director, Missouri Department of Health, a person has a constitutionally protected liberty interest in refusing unwanted medical treatment. 497 U.S. 261, 278, 110 S.Ct. 2841, 111 L.Ed.2d 224 (1990); see also Washington v. Harper, 494 U.S. 210, 221, 110 S.Ct. 1028, 108 L.Ed.2d 178 (1990) (recognizing a prisoner's significant liberty interest in avoiding the unwanted administration of antipsychotic drugs). 22 While decisions regarding medical treatment are normally private matters to be resolved between an individual and his or her physician, when these decisions occur in the prison setting, the government has a role. The state is obligated to provide medical care to those that it has incarcerated and thus made dependent on the care and services that it provides. Estelle, 429 U.S. at 103, 97 S.Ct. 285. As a result, these decisions usually involve state action. Because § 1983 liability attaches only when the constitutional deprivation is the result of state action, the following discussion applies only to doctors or other prison officials that are acting under color of state law. See 42 U.S.C. § 1983; see also Flagg Bros., Inc. v. Brooks, 436 U.S. 149, 156, 98 S.Ct. 1729, 56 L.Ed.2d 185 (1978) (recognizing liability under § 1983 for private individuals who cause a deprivation of a constitutional right when acting under color of state law). 23 In White v. Napoleon, 897 F.2d 103 (3d Cir.1990), the Third Circuit upheld a prisoner's claim that a prison doctor's refusal to answer his questions about prescribed medication violated the prisoner's Fourteenth Amendment rights. The court first recognized that prisoners, like nonincarcerated citizens, have a right to refuse medical treatment. Id. at 111. It then reasoned that the right to refuse that treatment has little meaning without sufficient knowledge of what the treatment entails. Id. at 113. Consequently, it held that [p]risoners have a right to such information as is reasonably necessary to make an informed decision to accept or reject proposed treatment, id., as well as a reasonable explanation of the viable alternative treatments available to them in the prison setting, id.; see also Benson v. Terhune, 304 F.3d 874, 884-85 (9th Cir.2002) (noting the Third Circuit's recognition of the right to medical information and describing it as a reasonable application of Supreme Court precedent); Clarkson v. Coughlin, 898 F.Supp. 1019, 1049 (S.D.N.Y.1995) (holding that the failure to provide such information as is sufficient to informed consent in a manner permitting the inmate/plaintiff to make a knowledgeable evaluation of his options is a violation of the inmate's due process rights to be free from unwanted medical treatment). 24 We agree with the Third Circuit that an individual cannot exercise his established right to refuse medical treatment in a meaningful and intelligent fashion unless he has sufficient information about proposed treatment. Absent knowledge of the risks or consequences that a particular treatment entails, a reasoned decision about whether to accept or reject that treatment is not possible. We therefore hold that, in order to permit prisoners to exercise their right to refuse unwanted treatment, there exists a liberty interest in receiving such information as a reasonable patient would require in order to make an informed decision as to whether to accept or reject proposed medical treatment. See White, 897 F.2d at 113 (Prisoners have a right to such information as is reasonably necessary to make an informed decision to accept or reject proposed treatment . . . .). 25 The entitlement to this information, however, is far from absolute. To establish a violation of the constitutional right to medical information, a prisoner must satisfy an objective reasonableness standard, must demonstrate that the defendant acted with the requisite state of mind, and must make a showing that the lack of information impaired his right to refuse treatment. 26
27 The right to medical information has an objective component. The prisoner is entitled only to such information as a reasonable patient would deem necessary to make an informed decision. This objective requirement limits the scope of the right in at least three ways. First, it precludes liability in cases where a prisoner may not have received all conceivable information regarding a particular treatment but a reasonable person would not find the missing information necessary to a decision regarding whether to go forward with that treatment. Second, it recognizes that prisoners' requests for information may range from reasonable to obstructionist. White, 897 F.2d at 113. Prisoners may not interfere with a prison's ability to provide medical attention to its inmates in an orderly, efficient manner by demanding unnecessary information during physician visits. Finally, it is not unlikely that, after receiving appropriate treatment that proved to have unpleasant side effects, a prisoner might claim that he had not received sufficient information to allow him to decide whether to refuse that treatment. To avoid liability in such situations, a doctor should not be required to provide each prisoner-patient with an exhaustive list of all the possible adverse effects of each aspect of his treatment. Instead, a doctor simply must provide a prisoner with such information as a reasonable patient would find necessary to making an informed decision regarding treatment options. 28
29 Inadvertent failures to impart medical information cannot form the basis of a constitutional violation. The simple lack of due care does not make out a violation of either the substantive or procedural aspects of the Due Process Clause of the Fourteenth Amendment. Davidson v. Cannon, 474 U.S. 344, 348, 106 S.Ct. 668, 88 L.Ed.2d 677 (1986); Daniels v. Williams, 474 U.S. 327, 332, 106 S.Ct. 677, 88 L.Ed.2d 662 (1986). In County of Sacramento v. Lewis, 523 U.S. 833, 118 S.Ct. 1708, 140 L.Ed.2d 1043 (1998), the Supreme Court considered what sort of executive action could qualify as a substantive due process violation. In that case, the parents of a motorcycle passenger killed in a high-speed police chase brought a § 1983 claim alleging deprivation of their son's substantive due process right to life. Id. at 837, 118 S.Ct. 1708. The Court began its analysis by reiterating that `the touchstone of due process is protection of the individual against arbitrary action of government.' Id. at 845, 118 S.Ct. 1708 (quoting Wolff v. McDonnell, 418 U.S. 539, 558, 94 S.Ct. 2963, 41 L.Ed.2d 935 (1974)) (alteration marks omitted). In the context of executive action, this means that the Due Process Clause is offended only if the government's abuse of power shocks the conscience. Id. at 846, 118 S.Ct. 1708; see also id. at 847 n. 8, 118 S.Ct. 1708 (1998) ([T]he threshold question is whether the behavior of the governmental officer is so egregious, so outrageous, that it may fairly be said to shock the contemporary conscience.). 30 In determining that injuries caused by high-speed chases do not give rise to Fourteenth Amendment liability unless the officers intend to harm the injured party, County of Sacramento recognized that the requisite state of mind for action by an executive official to satisfy the shocks the conscious test will vary according to the circumstances. Id. at 849-51, 118 S.Ct. 1708. Exigent circumstances, such as when prison officials are faced with a riot or when police encounter a situation calling for an immediate response, require that government actors make instant judgments that honor their competing obligations both to restore order and to act with restraint. In such crises, even precipitate recklessness fails to inch close enough to harmful purpose to spark the shock that implicates `the large concerns of the governors and the governed.' Id. at 853-54, 118 S.Ct. 1708 (quoting Daniels, 474 U.S. at 332, 106 S.Ct. 677). 31 By contrast, in situations where actual deliberation is possible, such as in the normal custodial circumstances of a prison, the state's duty to take responsibility for the inmates' safety and well-being `does not ordinarily clash with other equally important governmental responsibilities.' Id. at 851-52, 118 S.Ct. 1708 (quoting Whitley v. Albers, 475 U.S. 312, 320, 106 S.Ct. 1078, 89 L.Ed.2d 251 (1986)). As a result, forethought about an inmate's welfare is not only feasible but obligatory. Id. at 851, 118 S.Ct. 1708. 32 In establishing this dichotomy, County of Sacramento strongly suggests that in those circumstances when actual deliberation is possible, a showing of deliberate indifference will establish Fourteenth Amendment liability. See id. at 850-53, 118 S.Ct. 1708 ([L]iability for deliberate indifference to inmate welfare rests upon the luxury enjoyed by prison officials of having time to make unhurried judgments, upon the chance for repeated reflection, largely uncomplicated by the pulls of competing obligations.). Following the reasoning of County of Sacramento, we hold that in order to incur liability a prison official's failure to adequately inform a patient regarding that patient's proposed medical treatment must be done with, at a minimum, deliberate indifference to the prisoner's right to refuse treatment and that simple negligence will not suffice. 33
34 We emphasize that the right to medical information is not, in and of itself, an independent right. Rather, it is a derivative of the right to refuse treatment and extends only to those circumstances in which it will effectuate a patient's exercise of that underlying right. So as a threshold matter, a prisoner must show that, had he received information that was not given to him, he would have exercised his right to refuse the proposed treatment. Cf. Lewis v. Casey, 518 U.S. 343, 351, 116 S.Ct. 2174, 135 L.Ed.2d 606 (1996) (holding that, to state a claim for denial of the right to access the courts, a prisoner must demonstrate that the alleged shortcomings in the library or legal assistance program hindered his efforts to pursue a legal claim). That is to say, a prisoner must be able to establish that the underlying right at stake—the right to refuse treatment — actually was impaired by the state's failure to impart necessary information to the prisoner-patient. If a prisoner still would have accepted the proposed treatment, even if he had been given all of the necessary information regarding that treatment, then his right to refuse treatment has not been impaired, and the deprivation of medical information is of no consequence.