Opinion ID: 1917662
Heading Depth: 1
Heading Rank: 3

Heading: Preservation of Life

Text: The Commissioner contends that we should adopt the reasoning of the Iowa Supreme Court in Polk County Sheriff v. Iowa District Court for Polk County, 594 N.W.2d 421 (Iowa 1999), and conclude that, because Reid's condition is treatable and non-terminal, coupled with the absence of serious side effects, ... the State's interest in the preservation of life weighs heavily in the balance. In addition, the Commissioner maintains that even though there are legal and factual similarities between the present case and Polk, the Court of Special Appeals nonetheless disregarded Polk and chose to rely on cases that arose outside a prison context, and [did not] involve[ ] a refusal to undergo kidney dialysis. Accordingly, the Commissioner asserts that this Court should look to both Polk and Commissioner of Correction v. Myers, 379 Mass. 255, 399 N.E.2d 452 (1979), for guidance and conclude that the State's interest in the preservation of life outweighs the inmates's right to refuse medical treatment. Reid counters, arguing that there is nothing in the record of this case that compelled a finding ... [that the State's interest in preserving this patient's life will override the individual's decision to refuse medical treatment]. According to Reid, the Commissioner's expressed concerns regarding the preservation of life factor simply are insufficient for [a court] to divest a competent adult of his right to refuse medical treatment. Stouffer, 184 Md.App. at 283, 965 A.2d at 105. The Court of Special Appeals acknowledged [t]hat [Reid] suffer[s] from kidney disease and that this fact was established beyond any doubt at the hearing. Stouffer, 184 Md.App. at 280, 965 A.2d at 103. According to Dr. Telda, a physician employed by the State's prison medical contractor, Reid needed to receive medical treatment and dialysis for his end-stage renal disease and related illnesses, otherwise, [he] would suffer serious bodily injury or death. Stouffer, 184 Md.App. at 279-80, 965 A.2d at 102. The intermediate appellate court also pointed out that the trial judge expressly acknowledged that [Reid's] failure to accept medical treatment was potentially life-threatening, Stouffer, 184 Md.App. at 280, 965 A.2d at 103, and that Reid is a competent adult who, notwithstanding being `ill-informed in his own wisdom,' ... expressly stated his desire to forego medical treatment that he finds objectionable. Stouffer, 184 Md. App. at 283, 965 A.2d at 104. In reaching the conclusion that the preservation of life factor was not sufficient to overcome a competent adult's choice to refuse medical treatment, the Court of Special Appeals carefully considered the specific facts of this case. The court stated: Although [the Commissioner] advances a legitimate concern relating to the preservation of life factor, such an interest is not sufficient to overcome a competent adult's choice to refuse medical treatment. Notably, [Reid's] skepticism about his condition arises from the information that was provided to him from medical professionals that turned out to be inaccurate; namely, that he would immediately suffer severe symptoms if he discontinued dialysis, which subsequently did not happen when [Reid] ceased dialysis for weeks at a time. We note the same concerns as the circuit court regarding [Reid's] understanding as to the seriousness of his condition, but such concerns are insufficient for us to divest a competent adult of his right to refuse medical treatment. Stouffer, 184 Md.App. at 283, 965 A.2d at 104-105. In Polk, 594 N.W.2d at 423, Jerrell Brown, a pre-trial detainee, was held in the Polk County jail awaiting trial on drug related charges. While in jail, he received kidney dialysis treatments three times per week at Lutheran Hospital for a year and subsequently refused to continue with the dialysis treatments. Polk, 594 N.W.2d at 424. The County Sheriff filed an application in the district court seeking an order to compel Brown to submit to emergency treatment stemming from his refusal to continue dialysis. Polk, 594 N.W.2d at 423. Medical testimony presented at the hearing for emergency treatment revealed that Brown's kidneys were minimally functional and unless Brown received the treatment, he would die within one week, probably due to cardiac arrest. Id. Brown did not testify at the hearing. Id. A psychiatrist who evaluated Brown one day before the hearing testified. Id. The court considered both his oral testimony and written report. Id. According to the psychiatrist, Brown was competent, appeared to be of at least average intelligence, and understood the risks of ... discontinuing the treatment. Id. The psychiatrist testified further that, Brown said that spending any further time in any correctional facility was unacceptable and that he was going to stop his dialysis treatment `whether he was looking at another month, or another year, or another five years' in incarceration. Id. The psychiatrist's report also revealed that Brown stated that he was tired of the routine of being taken to the hospital in jail garb and in manacles only to have to return to jail. Polk, 594 N.W.2d at 425. Further, according to statements in the report attributable to Brown, `[Brown] ... decided to refuse any future dialysis until March 4, 1999,' which according to Brown was his pretrial conference date. Id. When [the psychiatrist] expressed doubt that Brown could live until March 4, Brown responded that he really did not care. Id. As Brown explained, I'd be dead, so there would be nothing to worry about. Id. The district court judge concluded that under the Fourteenth Amendment to the United States Constitution, Brown's liberty interest was superior to the State's interest in compelling Brown to submit to dialysis. Id. As a result, the court rejected the Sheriff's request for an order compelling medical treatment. Id. Subsequently, the Sheriff filed a petition for a writ of certiorari in the Iowa Supreme Court, which was granted. Id. The Iowa Supreme Court held: In balancing Brown's diminished liberty interest to refuse treatment against the State's countervailing interests in preserving life, preventing suicide, protecting the interests of innocent third parties, maintaining the ethical integrity in the medical profession, and maintaining prison security, order, and discipline, we conclude the State's interests must prevail. Polk, 594 N.W.2d at 431. The court reasoned that ordinarily a state's interests in [preserving] life are strong, [but] such interests standing alone will usually not preclude a competent person from declining life-sustaining medical treatment. Polk, 594 N.W.2d at 426. The underlying rationale for this approach, the court explained, is that the life the state is seeking to protect in such a situation is the life of the same person who has competently decided to forego the medical intervention; it is not some other actual or potential life that cannot adequately protect itself. Id. (internal citation omitted). Notwithstanding, in Brown's case the State's interest in the preservation of life weigh[ed] heavily in the balance because compelling Brown to submit to dialysis `d[id] not involve a situation where `heavy physical and emotional burdens' would be imposed to effect a brief and uncertain delay in the natural process of death.' Polk, 594 N.W.2d at 427 (quoting Myers, 399 N.E.2d at 456). In its analysis, the Iowa Supreme Court indicated that the State's interest in the preservation of life d[id] not alone control Brown's right to refuse treatment. Id. In addition, the court reasoned that it must also factor into [the] balancing process the magnitude of the invasion brought about by dialysis. Id. Thus, in the court's view, the degree of invasiveness was minimal. Apparently, the fact that death was certain, in the event that Brown discontinued dialysis, and that the dialysis procedure is not painful and produces no serious side effects informed the Iowa Supreme Court's decision that the State's interest in preserving life weighed heavy in the balance. Id. In rendering its decision, the court gave little or no consideration to the mental and emotional pain to Brown resulting from unwanted kidney dialysis treatment. Polk, 594 N.W.2d at 433 (Snell, J., dissenting); see also Brophy, 497 N.E.2d at 637 (acknowledging that the invasiveness of the treatment sought to be terminated is an important factor to be considered in balancing the individual's and the State's interests, but agreeing to adopt the view expressed by the New Jersey courts that the primary focus should be the patient's desires and experience of pain and enjoymentnot the type of treatment involved) (internal citations omitted); Myers, 399 N.E.2d at 457 (noting that dialysis is a relatively complex procedure, which requires considerable commitment and endurance from the patient who must undergo the treatment three times a week). In addition, as Justice Snell's dissenting opinion in Polk points out, the majority in Polk fundamentally undervalued the liberty interest of the Fourteenth Amendment when it recognized the State's interests as supreme even though they are totally unsupported by the evidence. Polk, 594 N.W.2d at 434 (Snell, J., dissenting). Further, the majority disregarded the principle announced by the United States Supreme Court in Cruzan that no person or court should substitute its judgment as to what would be an acceptable quality of life for another. Polk, 594 N.W.2d at 434 (Snell, J., dissenting) (quoting Cruzan, 497 U.S. at 275, 110 S.Ct. at 2849, 111 L.Ed.2d at 239 (internal citation omitted)). We simply are not persuaded that the State's interest in the preservation of life outweighs Reid's right to refuse medical treatment. Reid was skeptical about his medical condition because the information that was provided to him from medical professionals ... turned out to be inaccurate. Stouffer, 184 Md.App. at 283, 965 A.2d at 104. The information provided to him was that he would immediately suffer severe symptoms if he discontinued dialysis, which subsequently did not happen when [Reid] ceased dialysis for weeks at a time. Stouffer, 184 Md.App. at 283, 965 A.2d at 104-05. Even though Reid was ill-informed in his own wisdom, as found by the trial judge, he expressly refused to continue with medical treatment that he [found] objectionable. Stouffer, 184 Md. App. at 283, 965 A.2d at 104. As the Court of Special Appeals noted: [W]hen a competent adult refuses medical treatment, the State's interest in preserving the particular patient's life will not override the individual's decision. Even in cases where a patient's condition is curable, the State's interest in preserving life is diminished because the life that the [S]tate is seeking to protect in such a situation is the life of the same person who has competently decided to forgo the medical intervention. The State's duty to preserve life must also encompass a recognition of an individual's right to avoid circumstances in which the individual himself would feel that efforts to sustain life demean or degrade his humanity. Stouffer, 184 Md.App. at 282-83, 965 A.2d at 104 (citations omitted).