Court Opinion

ID: 9743678
Source: CourtListenerOpinion
Date Created: 2023-08-26 21:40:12.750164+00
Date Added: 2024-06-11T07:24:32.094346
License: Public Domain

DeBRULER, Justice,
concurring and dissenting.
Because the death of Sue Ann Lawrance has rendered the issues in this appeal moot, it should be dismissed. An appeal becomes moot and should be dismissed when the
*45controversy or dispute originally existing at the time of the commencement of the action ceases to be a concrete one requiring settlement, loses its essential character, is no longer live, or the court on appeal is unable to render effective relief. State ex rel. Gregory v. Boyd (1909), 172 Ind. 196, 87 N.E. 140; Bartholomew County Hosp. v. Ryan (1982), Ind.App., 440 N.E.2d 754. As pointed out in the majority opinion, a moot appeal may nevertheless be maintained and decided if it falls within the exception for questions of great public importance. Bartholomew County Hospital v. Ryan, 440 N.E.2d at 759; In re Marriage of Stariha (1987), Ind.App., 509 N.E.2d 1117, 1128. The case of State v. Davis (1958), 288 Ind. 568, 151 N.E.2d 495, involved such an appeal. There the trial court refused to order school children transferred from one school to another for the school year 1955-1956. On appeal by the parents this Court noted that the school year 1955-1956 had long since passed and that the specific question was moot, but decided the case on its merits under the exception because "the same question reoe-curs year after year as to the appellants and the parents of other children throughout the state...." Id. 151 N.E.2d at 497. This statement supports and exemplifies the repeated holding of the Court of Appeals that the public interest exception requires the elements of (1) likely reoceur-rence, and (2) a context which will continue to evade review. Bartholomew County Hosp. v. Ryan. The need of parents to transfer their children was a reoccurring one and the context of it would be a time so short as to render appellate review unavailable.
Persons like Sue Ann Lawrance who reach a persistent unconscious state while being provided with only food and fluid can be expected to live for long periods of time. This is the position of the American Academy of Neurology. Position of the American Academy of Newrology on Certain Aspects of the Care and Management of the Persistent Vegetative State Patient, 39 Neurology 125, 125-26 (1989). Therefore, there is no reason to believe that such persons will die before court judgments defining their proper treatment can be fully considered on appeal. Such appeals will not evade review. Furthermore, I am not satisfied that this is a case likely to reoec-eur. There cannot be many persons who, like Sue Ann Lawrance, are non-terminal, being maintained in a persistent vegetative state on food and water, and have never been competent during their lifetimes to make medical treatment decisions. It is a special and unusual case. Because this appeal is moot and does not fall within an exception it should be dismissed.
The majority of the Court has ruled that this appeal falls within an exception to the mootness rule and proceeds to address several important issues. Because of this ruling and the fact that the majority opinion sets the course for the law in this class of cases, I deem myself obligated to render my own view on several issues. With respect to the proper construction of the Health Care Consent Act, LC. 16-8-12-1, et seq., I find a single form of court jurisdiction recognized in it and that form is probate jurisdiction. Probate jurisdiction is to be exercised by courts in accordance with I.C. 16-8-12-7. I read the amended petition of the Lawrance parents as one seeking court approval of a particular health care decision, which could only be appropriate under section 7. Because section 7 was not complied with by giving notice to the person alleged to be incapable of consenting, Sue Ann Lawrance, an incompetent person, as required by due process, the judgment should be reversed. Covey v. Town of Somers, 351 U.S. 141, 76 S.Ct. 724, 100 L.Ed. 1021 (1956). If the statute did not have this requirement of notice, Article 1, Section 12 of the Indiana Constitution would impose it. See Mueller v. Mueller (1972), 259 Ind. 366, 287 N.E.2d 886. As Justice Frankfurter wrote, "The history of liberty has largely been the history of observance of procedural safeguards." McNabb v. United States, 318 U.S. 332, 347, 63 S.Ct. 608, 616, 87 L.Ed. 819, 827-28 (1943).
The purpose of this Act is to facilitate the delivery of "health care" by "health care provider[s]" to individuals who are *46"incapable of consenting." Some facilitation is needed because the delivery of health care is impeded where the civil law requires informed consent of the patient for that delivery and the patient is "incapable of consenting," and because the health care provider runs the risk of civil suit when providing "health care" without consent of the patient. The Act is intended to apply broadly to the customary and routine medical practice. See Thompson, Indiana's New Health Care Consent Act: A Guiding Light for the Health Care Provider, 21 Ind.L.Rev. 181, 182 (1988). The Act serves its purpose by providing the broadest possible definition of the terms "health care" and "health care providers," and then giving legal recognition to con-
Having declared itself applicable to the entire health care realm, the Act then assures the reader in the last two sections that it is not defining as a matter of Indiana law and public policy the extent of that realm. Specifically, 1.C. 16-8-12-11(a), (c), (e)(1), (e)(2), and I.C. 16-8-12-12, provide:
This chapter does not affect Indiana law concerning an individual's authorization to make a health care decision for the individual or another individual, or to provide, withdraw, or withhold medical care necessary to prolong or sustain life.
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This chapter does not authorize an individual to consent to any health care that is prohibited under Indiana law.
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This chapter does not affect Indiana law concerning:
The standard of care of a health care
provider required in the provision of health care;
When consent is required for health care;
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Nothing in this chapter may be construed to authorize euthanasia.
These provisions instruct the reader that it is not the purpose of this statute to provide the basis for answering a question of whether a particular proposed "health care" requires consent. The question is valid, but the answer to such questions is to be found elsewhere. "Health care" is not defined in this act for such purposes. The statute is silent on the critical issues in this appeal.
The co-petitioners, parents of Sue Ann Lawrance, in their amended petition asked the Court to sanction consent to a particular form of "health care," namely "the withdrawal of artificially delivered nutrition and hydration for their daughter, Sue Ann Lawrance." The trial court granted that part of the petition saying:
[This Court now Orders and Adjudges that the Co-petitioners herein, William and Bonita Lawrance, do have the authority under I.C. § 16-8-12-1 et seq. to consent, as surrogate decision makers, to the withdrawal of artificially delivered nutrition and hydration from their daughter....
The amended order went on to restrain the State Board of Health and all health care providers from interfering with the execution of this plan. Clearly this order was not made by the probate court pursuant to the authority of 1.0. 16-8-12-7, but rests upon the remainder of the Act which cannot possibly support it. The next question is whether the order is supported by other lawful authority.
Recognition of the basic natural rights of each person to life and liberty is the starting point for courts in dealing with cases of this class. Article 1, Section 1, Indiana Constitution. Protection for life and liberty is guaranteed by the constitution. Article 1, Sections 1 and 12, Indiana Constitution. Courts must be vigilant in cases coming before them to protect these basic natural rights. The common law recognizes the right of the individual to refuse medical treatment in appropriate circumstances. See Payne v. Marion General Hospital (1990), Ind.App., 549 N.E.2d 1043; In re Quinlan, 70 N.J. 10, 855 A.2d 647 (1976); In re Eichner v. Dillon, 52 N.Y.2d 363, 420 N.E.2d 64, 438 N.Y.S.2d 266 (1981); Superintendent of Belchertown State School v. Saikewicz, 373 Mass. 728, 370 N.E.2d 417 *47(1977). The Massachusetts Supreme Judicial Court stated:
A person has a strong interest in being free from nonconsensual invasion of his bodily integrity, and a constitutional right of privacy that may be asserted to prevent unwanted infringements of bodily integrity. Thus a competent person has a general right to refuse medical treatment in appropriate circumstances, to be determined by balancing the individual interest against counterveiling State interests, particularly the State interest in the preservation of life. In striking that balance account is to be taken of the prognosis and of the magnitude of the proposed invasion. The same right is also extended to an incompetent person, to be exercised through a 'substituted judgment' on his behalf. The decision should be that which would be made by the incompetent person, if he were competent, taking into account his actual interests and preferences and also his present and future incompetency.
In re Spring, 380 Mass 629, 634, 405 N.E.2d 115, 119 (1980) (discussing Satkew-icz) I take it as axiomatic, requiring no citation of authority, that this right does not include (1) a right to commit suicide, (2) a right to mutilate one's own body, (8) a right to have one's life taken by another, or (4) a right to have one's dying expedited by participation of others.
The amended petition below sought a form of relief which posed a threat to the life of Sue Ann Lawrance. Because of this, the trial court was called upon to exercise a heightened vigilance. At the time of the hearing in the trial court, Sue Ann Lawrance was in her early forties and had been essentially unconscious since 1987. The majority opinion describes her youth:
Ms. Lawrance had been healthy until the age of nine, when she displayed symptoms of intracranial pressure and underwent a craniotomy ... She suffered permanent brain damage and attended special schools and camps for the mentally handicapped.
Majority opinion at 35. She had never been competent to make a personal health care decision. Her physicians were of the opinion that she would not regain consciousness. She had extensive brain damage to the frontal portions of the brain; however, the brain stem was healthy and her EEG showed slow and erratic activity in the frontal regions. She was not brain dead. Thus, she breathed spontaneously and regularly; her heart beat spontaneously and regularly; and her other vital signs were normal. It is profoundly important that she was not terminally ill and was not suffering.
At the time she had an ideal body weight. Her skin condition was good. She had no bed sores. She was receiving some minor medications and had had several seizures lasting a few minutes over a period of months which, in the opinion of the neurologist, were the product of her unconscious, non-responsive existence.
She was being maintained in this totally helpless state by food and liquids provided her through a stomach tube. She was being cared for by providers who loved her and took care of her. She was bathed and kept clean, and often propped up in a wheel chair and taken from her room. They dreaded the thought of withdrawing her care. If this process of feeding had been stopped, she would have eventually died of starvation or dehydration.
The stomach tube had been surgically implanted and in constant use for a long time when the hearing in court took place. The invasion of her body involved in those activities is not directly involved here. Here it is the maintenance of the tube and its continued use to deliver basic food and liquid which is at stake. The maintenance of the tube and its continued use are certainly invasive of the person, but I judge not greatly so. There are no chemicals or medicines involved which alter one's mental or physical processes. The natural processes in the stomach and intestines are utilized. It is a simple, clean process which does not involve a great deal of liquid or the expenditure of a great deal of time by health care providers. A person who persists in life with only such basic support, *48without pain and suffering, with the strength to fight off illness and disease, though unconscious and unable to react with other human beings, is not greatly burdened by that support. One cannot help but compare this burden with the crushing ones of hemodialysis, peritoneal dialysis, and certain forms of chemotherapy.
The state's interest against which the patient's interest in self-determination may be balanced has been recently considered to have four manifestations, namely, the interest in preserving life, the interest in preventing suicide, the interest in safeguarding the integrity of the medical profession, and the interest in protecting innocent third parties. In re Conroy, 98 N.J. 321, 348-53, 486 A.2d 1209, 1223-25 (1985). In Indiana, 410 IAC 16.2-38-7 contains food and nutrition regulations promulgated pursuant to I.C. 16-10-4-5. The regulations apply to Health Care Facilities and mandate that the basic nutritional needs of all residents be met. Here, on balance, the right of Sue Ann Lawrance to refuse unwanted treatment in the form of artificially delivered food and hydration, exercised for her by her parents without knowledge of a personal choice by Sue Ann Lawrance, gives way to the counterveiling state interest in preserving her life. On the facts in this record, the order approving the withdrawal of her life-sustaining nutrition and hydration does not find legal justification and should be reversed.