Opinion ID: 173410
Heading Depth: 3
Heading Rank: 1

Heading: The Jensens' Substantive Due Process Right to Direct P.J.'s Medical Care

Text: The district court concluded that the Jensens failed to show that any defendant violated their right to direct P.J.'s medical care. Because the district court decided this issue under the first prong of the qualified immunity analysis, it did not have occasion to consider whether the Jensens' right to direct P.J.'s medical care in the circumstances presented in this case was clearly established at the time of the alleged violations. Furthermore, on appeal, the Jensens confine their argument to the first prong of the qualified immunity analysis and assume that under the circumstances of this case their right to direct P.J.'s medical care is clearly established. We reject this assumption and conclude that the Jensens' right to direct P.J.'s medical care in this caseif any right indeed exists in such circumstanceswas not clearly established at the time the Jensens allege the right was violated. We begin by acknowledging that the Due Process Clause generally provides constitutional protection for parental rights. Indeed, the Supreme Court has stated that the Due Process Clause of the Fourteenth Amendment protects the fundamental right of parents to make decisions concerning the care, custody, and control of their children. Troxel v. Granville, 530 U.S. 57, 66, 120 S.Ct. 2054, 147 L.Ed.2d 49 (2000). Furthermore, although we have never specifically recognized or defined the scope of a parent's right to direct her child's medical care, see Roska v. Peterson, 328 F.3d 1230, 1247 n. 14 (10th Cir.2003) (We express no opinion on whether such a right [to direct a child's medical care] might exist within the context of general familial rights.), we do not doubt that a parent's general right to make decisions concerning the care of her child includes, to some extent, a more specific right to make decisions about the child's medical care. See Dubbs v. Head Start, Inc., 336 F.3d 1194, 1203 (10th Cir. 2003) (It is not implausible to think that rights invoked herethe right to refuse a medical exam and the parent's right to control the upbringing, including the medical care, of a childfall within [the Due Process Clause's] sphere of protected liberty.). The Supreme Court has similarly alluded to, but never specifically defined the scope of a parent's right to direct her child's medical care. Indeed, the Court has recognized that [m]ost children, even in adolescence, simply are not able to make sound judgments concerning ... their need for medical care or treatment, Parham v. J.R., 442 U.S. 584, 603, 99 S.Ct. 2493, 61 L.Ed.2d 101 (1979), and that our legal system presumes that natural bonds of affection lead parents to act in the best interests of their children. Id. at 602., 99 S.Ct. 2493 Therefore, this precedent reasonably suggests that the Due Process Clause provides some level of protection for parents' decisions regarding their children's medical care. The Supreme Court has long recognized, however, that parental rights, including any right to direct a child's medical care, are not absolute. See Prince v. Massachusetts, 321 U.S. 158, 166, 64 S.Ct. 438, 88 L.Ed. 645 (1944) ([N]either rights of religion nor rights of parenthood are beyond limitation.); see also Parham, 442 U.S. at 604, 99 S.Ct. 2493 ([P]arents cannot always have absolute and unreviewable discretion to decide whether to [seek specific medical care for their children], but they retain plenary authority to seek such care for their children, subject to a physician's independent examination and medical judgment.). Indeed, states have a compelling interest in and a solemn duty to protect the lives and health of the children within their borders. See, e.g., Globe Newspaper Co. v. Superior Court for Norfolk County, 457 U.S. 596, 607, 102 S.Ct. 2613, 73 L.Ed.2d 248 (1982) ([S]afeguarding the physical and psychological well-being of a minor ... is a compelling [interest].). Accordingly, when a child's life or health is endangered by her parents' decisions, in some circumstances a state may intervene without violating the parents' constitutional rights. See Parham, 442 U.S. at 603, 99 S.Ct. 2493 ([W]e have recognized that a state is not without constitutional control over parental discretion in dealing with children when their physical or mental health is jeopardized.). Under this constitutional framework, we conclude that the Jensens' asserted right to direct P.J.'s medical care in this case is not clearly established. The record demonstrates that no less than seven qualified and competent doctors evaluated P.J., diagnosed him with life-threatening cancer, and recommended that he immediately undergo chemotherapy treatment in order to save his life. In this particular situation, the Jensens did not have a clearly established constitutional right to refuse the unanimous recommended treatment or to solicit additional opinions until they found a doctor who disagreed that conventional treatment was necessary. Indeed, the Jensens had a `high duty' to recognize symptoms of illness and to seek and follow medical advice. Id. at 602., 99 S.Ct. 2493 Furthermore, when a child's life is under immediate threat, a state's interest in protecting the child is at its zenith, and a state has broad authority to intervene in parental decisionmaking that produces the threat to the child's life. See Prince, 321 U.S. at 167, 64 S.Ct. 438 ([T]he state has a wide range of power for limiting parental freedom and authority in things affecting the child's welfare.). Here, the state was endowed with this broad authority, and the Jensens do not direct us to a clearly established constitutional line that defines what a state can and cannot do to protect a child whose life is compromised by his parents' refusal to obtain medical care. Certainly, the Jensens do not assert any factual allegation that is substantially supported in the record which would constitute state action that is clearly outside the state's wide range of power. Accordingly, under the circumstances of this case, the Jensens' asserted right to direct P.J.'s medical care was not clearly established at the time of the alleged violations; therefore, they cannot overcome the defendants' claims of qualified immunity.