Opinion ID: 1985823
Heading Depth: 1
Heading Rank: 5

Heading: right of self-determination substituted judgment for incompetent

Text: More than a century ago, the United States Supreme Court recognized that no right is held more sacred, or is more carefully guarded by the common law, than the right of every individual to the possession and control of his [or her] own person, free from all restraint or interference of others, unless by clear and unquestionable authority of law. Union Pac. Ry. Co. v. Botsford, 141 U.S. 250, 251, 11 S.Ct. 1000, 1001, 35 L.Ed. 734 (1891). The foregoing principle is one of the unalienable rights of life and liberty described in the Preamble to the Declaration of Independence. Cf. Severns I, 421 A.2d at 1344. The preservation of that common law right of self-determination has been implemented by the Fifth Amendment to the United States Constitution and Article I, § 7 of the Delaware Constitution. A competent person's constitutional right of self-determination cannot be eliminated by statute. Del. Const. art. I, § 9. This Court has recognized that the constitutional right of self-determination is not lost when an individual becomes incompetent. Severns I, 421 A.2d at 1347; see also In re Jobes, Supr., 108 N.J. 394, 529 A.2d 434 (1987). Therefore, an incompetent person does not lose his or her right to withhold or withdraw life-sustaining treatment. Severns I, 421 A.2d at 1347. To give effect to an incompetent person's rights, this Court has held that the guardian of the person has standing to invoke and vicariously assert the constitutional right of an incompetent ward to accept medical care or to refuse it. Id. The term substituted judgment is commonly used to describe that process. In re Jobes, 529 A.2d at 450. The purpose of the substituted judgment doctrine is to ensure that the surrogate decisionmaker effectuates the decision that the incompetent patient would have made if he or she were competent. Under the substituted judgment doctrine, where an incompetent's wishes are not clearly expressed, a surrogate decisionmaker considers the patient's personal value system for guidance. The surrogate considers the patient's prior statements about and reactions to medical issues, and all the facets of the patient's personality that the surrogate is familiar with  with, of course, particular reference to his or her relevant philosophical, theological, and ethical values  in order to extrapolate what course of medical treatment the patient would choose. Id. When a person has clearly expressed his or her prior intentions about a course of treatment in the event of incompetency, those intentions should be respected. See Cruzan v. Director, Mo. Dept. of Health, 497 U.S. 261, 289-90, 110 S.Ct. 2841, 2857-58, 111 L.Ed.2d 224 (1990) (O'Connor, J., concurring opinion). As Justice O'Connor noted, however: few individuals provide explicit oral or written instruction regarding their intent to refuse medical treatment should they become incompetent. Id. at 289, 110 S.Ct. at 2857. Similarly, the Wisconsin Supreme Court noted that: [r]elatively few individuals provide explicit written or oral instructions concerning their treatment preferences should they become incompetent. The reasons for this are undoubtedly myriad: ignorance, superstition, carelessness, sloth, procrastination or the simple refusal to believe it could happen to oneself. This failure to act is not a decision to accept all treatment, nor should society's increasing ability to prolong the dying process make it one. In re Guardianship of L.W., Supr., 167 Wis.2d 53, 482 N.W.2d 60, 67-68 (1992). When an incompetent person has not expressed his or her intentions regarding the withholding or withdrawal of treatment in accordance with a statutory formality, the substituted judgment by the guardian of the person best accomplishes the goal of having the ward make his or her own decision. See Severns I, 421 A.2d at 1347; In re Jobes, 529 A.2d at 451.