Opinion ID: 2634033
Heading Depth: 1
Heading Rank: 6

Heading: The DOC Fails to Present a Compelling Interest

Text: ¶ 63 According to the lead opinion the DOC presents five compelling interests: (1) maintenance of prison security and administration, (2) preserving life, (3) protecting third parties, (4) preventing suicide, and (5) maintaining the ethical integrity of the medical profession. Lead op. at 1264-65. After hasty analysis the lead opinion finds four of these interests outweigh Mr. McNabb's right to bodily integrity. It is unclear whether any one of these interests is sufficient to outweigh McNabb's right to bodily integrity because the lead opinion does not provide such clarity. ¶ 64 Another reason the lead opinion lacks clarity as to whether an inmate's right to refuse food might ever outweigh the State's interests is the lead opinion's balancing of interests. Such balancing allows courts and parties alike great discretion in determining (or arguing) when the rights/interests of one party outweigh the rights/interests of another, resulting in malleable and unpredictable law. See Crawford v. Washington, 541 U.S. 36, 68-69, 124 S.Ct. 1354, 158 L.Ed.2d 177 (2004) (By replacing categorical constitutional guarantees with open-ended balancing tests, we do violence to their design. Vague standards are manipulable. . . .). Moreover, the lead opinion gives deference to the government at the expense of the individual notwithstanding our duty of impartiality between parties. See Code of Judicial Conduct, Canon 3(A)(5). ¶ 65 The lead opinion affords DOC substantial deference by assuming the existence of DOC's first compelling interest (prison security and administration) without the benefit of a single affidavit or example of a deleterious effect on prison staff or population, making the DOC's burden to demonstrate a compelling interest significantly lighter. Lead op. at 1265 (citing Turner v. Safley, 482 U.S. 78, 85, 107 S.Ct. 2254, 96 L.Ed.2d 64 (1987)). However, the greater the intrusion into a protected interest, the greater the necessity for some factual basis to support the prison official's assertions. See Turner, 482 U.S. at 97-99, 107 S.Ct. 2254 (holding the penological interest in completely restricting marriage was unsupported by the record); see also Joel K. Greenberg, Note, Hunger Striking Prisoners: The Constitutionality of Force-Feeding, 51 FORDHAM L.REV. 747, 766 (1983). ¶ 66 Here, absent any supporting evidence from DOC the lead opinion concludes, [i]t is logical to infer that an inmate's slow death by starvation would have an unpredictable and deleterious effect on both prison staff and the prison population. Lead op. at 1265. This speculative inference alone convinces the lead opinion a compelling interest exists sufficient to justify the most coercive intrusion into Mr. McNabb's body. ¶ 67 How is making the prison staffs job more palatable sufficiently compelling to justify intruding into Mr. McNabb's bodily integrity? How does respecting Mr. McNabb's bodily integrity result in prisoner unrest? Is not prisoner unrest more likely when prisoners learn they have lost the right to bodily integrity? Moreover, assuming death is the result of Mr. McNabb's fast, is it not equally, if not more, logical to infer inmates will follow his lead when they learn they are protected from that result? See Graham Zellick, The Forcible Feeding of Prisoners: An Examination of the Legality of Enforced Therapy, 1976 PUB.L. 153, 175. ¶ 68 Mr. McNabb is not fasting to manipulate or seek favors from prison officials. [10] He has signed a health care directive pursuant to RCW 70.122.030, indicating his intent (should he be diagnosed to be in terminal or permanent unconscious condition) to exercise his right to refuse medical or surgical treatment and to accept the consequences of such refusal. I am declining to eat for personal reasons. I am competent to make this choice. I have not been declared incompetent. . . . I am not using my fast as a means to seek or ask for any special privileges or favors or otherwise attempt to manipulate the system. My only wish is for my personal decision not to eat to be respected and to be left in peace for my fast to take its course. . . . I have no dependents or anyone else relying on me for support. My decision not to eat affects only me. Decl. of Charles B. McNabb. ¶ 69 McNabb's refusal to eat is a private and personal choice. Because DOC presented no evidence (only mere conjecture) that Mr. McNabb's refusal of food and drink will disrupt prison administration, the DOC unnecessarily violates McNabb's right to bodily integrity. ¶ 70 The lead opinion declares the DOC's second interest (preservation of life) exists because the State has a strong interest in the preservation of life where medical treatment will in fact save the patient's life. Lead op. at 1266 (citing In re Welfare of Colyer, 99 Wash.2d 114, 123, 660 P.2d 738 (1983), overruled in part by In re Guardianship, of Hamlin, 102 Wash.2d 810, 689 P.2d 1372 (1984)). Yet the value of life is desecrated not by a decision to refuse medical treatment but `by the failure to allow a competent human being the right of choice.' In re Guardianship of Farrell, 108 N.J. 335, 349, 529 A.2d 404, 411 (1987) (quoting In re Conroy, 98 N.J. 321, 343, 350, 486 A.2d 1209 (1985)). ¶ 71 The lead opinion perceives a distinction in our case law between removing life- sustaining. treatment [and] refusing life- saving treatment. Lead op. at 1266. According to the lead opinion McNabb does not suffer from a terminal condition and DOC's application of its force-feeding policy does not merely temporarily relieve a chronic condition but restores McNabb to a naturally healthy condition. Id. ¶ 72 The distinction between life- sustaining treatment and life- saving treatment is irrelevant. [11] We all suffer from this terminal condition requiring food to sustain our life, some of us more than others. Like the respirator artificially inflating the lungs until the next breath, force-feeding artificially fills the stomach until the next feeding. The only distinction between the two is the time interval involved before the next artificial intervention is necessary to sustain life. Force-feeding does not cure a need to eat any more than forced breath cures the need to breathe. Both conditions are chronic and incurable. ¶ 73 Furthermore, force-feeding an inmate in the interest of his or her purported welfare is disingenuous at best. See In re Caulk, 125 N.H. 226, 236, 480 A.2d 93 (1984) (Douglas, J., dissenting) (The majority's reliance on the fact that Mr. Caulk is not facing death from a terminal illness ignores the nonphysical quality of life and reduces the quality of life to mere physical well-being.). ¶ 74 Force-feeding will not rehabilitate Mr. McNabb or contribute to his welfare; by contrast, force-feeding is degrading and cruel. As this court noted in Grant, 109 Wash.2d at 560, 747 P.2d 445, advanced methods of providing nutrition and hydration, while often safe, are not without risks. These are sophisticated medical procedures whose benefits must be weighed against their burdens. Patients requiring nutrition and hydration are subjected to highly invasive and intrusive procedures. Id. ¶ 75 This court has previously referred to the State's interest in protecting the sanctity [12] of life. Colyer, 99 Wash.2d at 122, 660 P.2d 738. If the State truly seeks to preserve the sanctity of inmates' lives, force-feeding prisoners does precisely the opposite by dehumanizing them. Respecting a person's bodily integrity recognizes the sanctity of life, namely a person's life is his alone, it is not owned by the State. To say otherwise justifies slavery. One's bodily integrity  the ultimate privacy protected under article I, section 7  is simply beyond the power of the State absent that authority of law provided by a warrant, obviously absent here. ¶ 76 Analyzing the State's third interest (protecting third parties) the lead opinion admits, the State lacks a compelling interest on this count given that [McNabb] has no dependents. Lead op. at 1266. ¶ 77 The lead opinion declares the State's fourth interest (the prevention of suicide) exists because McNabb set in motion and intended to cause his death. Lead op. at 1266. The lead opinion distinguishes a terminally ill patient refusing life-saving treatment from McNabb, id., since under our case law persons in advanced stages of terminal and incurable illnesses are entitled to withdraw or withhold medical treatment. See Grant, 109 Wash.2d at 559, 747 P.2d 445. Our prior decisions suggest the State's interest to prevent suicide is implicated where a patient's death is set in motion [or] intended by the patient. Id. at 556-57, 747 P.2d 445; Colyer, 99 Wash.2d at 123, 660 P.2d 738. ¶ 78 McNabb correctly points out the bizarre ramifications of the State's interest in preventing suicide being implicated when death is set in motion or intended by the patient. A literal interpretation of Grant and Colyer suggests an individual whose death is set in motion because of his own actions loses the right to refuse life-sustaining treatment. By extension, does this mean the State could force a woman with a life-threatening pregnancy to submit to an abortion? Or could the State force an inmate who contracted lung cancer after years of smoking to undergo chemotherapy? Technically, both of these conditions were set in motion by the individual. And yet, forcing an abortion or cancer treatment upon an inmate is unthinkable to most. Likewise, since the State's interest in preventing suicide is based on theological doctrine, its constitutional validity is questionable. [13] ¶ 79 Properly stated, the State's prevention of suicide interest is concerned with preventing irrational acts of self-destruction, the impulsive act of irreparable consequence. See Superintendent of Belchertown State Sch. v. Saikewicz, 373 Mass. 728, 744 n. 11, 370 N.E.2d 417 (1977). Fasting, however, is not an impulsive act of irreparable consequence but a daily commitment and affirmation of belief. [14] As Judge Benjamin Cardozo eloquently stated, [e]very human being of adult years and sound mind has a right to determine what shall be done with his own body. Schloendorff v. Soc'y of N.Y. Hosp., 211 N.Y. 125, 129, 105 N.E. 92 (1914). This includes fasting for whatever reason. ¶ 80 More importantly, however, the lead opinion never explains why Mr. McNabb's presumed motivation for fasting is relevant to the recognition of his constitutional right. Do we condition the exercise of religion on proper motivation? How about speech? Do we say to a woman, you may get an abortion but only if we agree with your motives? The lead opinion designs a brave new world, [15] where right thinkers have rights and wrong thinkers are subservient to the will of the masses. ¶ 81 Why Mr. McNabb wants to live free from governmental intrusion into his body is irrelevant to whether he has the right to live free from governmental intrusion into his body. Mr. McNabb is not incompetent, and we should recognize his right to refuse force-feeding. ¶ 82 Finally, the lead opinion concludes its fifth state interest (the maintenance of medical ethics) weighs in favor of the government. Lead op. at 1266. To this I simply point to the World Medical Association, of which the American Medical Association is a member, and its policy prohibiting the force-feeding of hunger striking prisoners. World Med. Ass'n, World Medical Association Declaration on Hunger Strikers princ. 3 (1992) (revised by the World Med Ass'n Gen. Assembly, Oct. 2006), available at http://www.wma. net/e/policy/h31.htm (last visited Mar. 5, 2008) (Forced feeding contrary to an informed and voluntary refusal is unjustifiable. Artificial feeding with the hunger striker's explicit or implied consent is ethically acceptable.); see also Physicians for Human Rights, Forced Feeding of Gitmo Detainees Violates International Medical Code of Ethics (Sept. 16, 2005), available at http:// physiciansforhumanrights.org/library/news-2005-09-16.html (last visited Mar. 5, 2008).