Court Opinion

ID: 9719938
Source: CourtListenerOpinion
Date Created: 2023-08-26 08:09:59.70795+00
Date Added: 2024-06-11T18:24:11.482131
License: Public Domain

SNELL, Justice,
(dissenting).
I respectfully dissent. I join Justice Cady’s dissent with these additional comments. The majority’s application of the legal principles that are appropriate to this issue seriously diminishes, if not eliminates, to a pretrial detainee the liberty interest established by the United States Constitution. Under the majority’s analysis, it would be extremely unlikely that any exercise of the liberty interest to refuse unwanted medical treatment would be upheld over a jailer’s objection. This is because a jailer could always conjure up a fear that a prisoner’s act of exercising his constitutional liberty interest would have a “fallout” effect on other prisoners. This *432possible fallout effect allegedly would then cause serious adverse consequences to the jail’s security, order and discipline requirements. As viewed by the majority, that possibility is enough to tip the scales under the balancing test and necessitate a jettisoning of the liberty interest of the United States Constitution. A possibility of fallout is all that the sheriff puts forth as evidence. Beyond that, there is no foundational support in fact for the premise that prison security, order and discipline would be seriously affected adversely if Brown were allowed to exercise his constitutional right.
The liberty interest guaranteed by the United States Constitution is found in the Fourteenth Amendment that provides that no State shall “deprive any person of life, liberty, or property, without due process of law.” U.S. Const, amend. XIV. The principle that a competent person has a constitutionally protected liberty interest in refusing unwanted medical treatment has been firmly established by the United States Supreme Court. See Cruzan v. Director, Missouri Dep’t of Health, 497 U.S. 261, 278, 110 S.Ct. 2841, 2851, 111 L.Ed.2d 224, 241 (1990). Such a principle has been inferred in the Court’s earlier decisions. As early as 1891, the Supreme Court recognized that “[n]o right is held more sacred, or is more carefully guarded, by the common law, than the right of any individual to the possession and control of his person, free from all restraint or interference of others, unless by clear and unquestionable authority of law.” Union Pacific R.R. v. Botsford, 141 U.S. 250, 251, 11 S.Ct. 1000, 1001, 35 L.Ed. 734, 737 (1891).
This notion of bodily integrity has been embodied in the requirement that informed consent is generally required for medical treatment. Justice Cardozo, while on the Court of Appeals of New York, aptly described this doctrine: “Every human being of adult years and sound mind has a right to determine what shall be done with his own body; and a surgeon who performs an operation without his patient’s consent commits an assault, for which he is liable in damages.” Schloendorjf v. Society of New York Hospital, 211 N.Y. 125, 129-130, 105 N.E. 92, 93 (1914) [overruled in part on other grounds by Bing v. Thun-ig, 2 N.Y.2d 656, 163 N.Y.S.2d 3, 143 N.E.2d 3 (1957) ]. The informed consent doctrine has become firmly entrenched in American tort law. See Keeton, Dobbs, Keeton, & Owen, supra, § 32, pp. 189-192; F. Rozovsky, Consent to Treatment, A Practical Guide 1-98 (2d ed.1990).
The logical corollary of the doctrine of informed consent is that the patient generally possesses the right not to consent, that is, to refuse treatment.
Cruzan, 497 U.S. at 269-70, 110 S.Ct. at 2846-47, 111 L.Ed.2d at 236.
The Supreme Court has also held that the forcible injection of medication into a nonconsenting person’s body represents a substantial interference with that person’s liberty. Washington v. Harper, 494 U.S. 210, 221-22, 110 S.Ct. 1028, 1036, 108 L.Ed.2d 178, 197-98 (1990). Even children have a substantial liberty interest in not being confined unnecessarily for medical treatment. Parham v. J.R., 442 U.S. 584, 600, 99 S.Ct. 2493, 2503, 61 L.Ed.2d 101, 117 (1979).
As a pretrial detainee, Brown is confined, both at the jail and at the hospital, where he is forced to receive unwanted medical treatment. The additional form of confinement inherent in the imposition of unwanted medical treatment was addressed by Justice O’Connor in stating:
The State’s imposition of medical treatment on an unwilling competent adult necessarily involves some form of restraint and intrusion. A seriously ill or dying patient whose wishes are not honored may feel a captive of the machinery required for life-sustaining measures or other medical interventions. Such forced treatment may burden that individual’s liberty interest as much as any state coercion.
*433Cruzan, 497 U.S. at 288, 110 S.Ct. at 2856, 111 L.Ed.2d at 248 (O’Connor, J., concurring).
In upholding this liberty interest, the Supreme Court has recognized that it is derived from a long history. It has been protected as a constitutional right, a common law right to privacy, a common law right to informed consent and the right to self-determination. See id. at 269-73, 110 S.Ct. at 2846-48, 111 L.Ed.2d at 236-38.
Regarding the conflict between individual constitutional rights and the interests of the state, the Supreme Court quoted with approval language from the New Jersey Supreme Court. It said:
On balance, the right to. self-determination ordinarily outweighs any counter-prevailing state interests, and competent persons generally are permitted to refuse medical treatment, even at the risk of death. Most of the cases that have held otherwise, unless they involved the interest in protecting innocent third parties, have concerned the patient’s competency to make a rational arid considered choice.
Id. at 273, 110 S.Ct. at 2848, 111 L.Ed.2d at 238 (quoting In re Conroy, 98 N.J. 321, 486 A.2d 1209,1225 (1985)).
In the case at bar, there is no question that Brown is competent to make a rational and considered choice.
In Bell v. Wolfish, the Supreme Court examined the constitutional rights of pretrial detainees — those persons who have been charged with a crime but who have not yet been tried on the charge. Bell v. Wolfish, 441 U.S. 520, 545, 99 S.Ct. 1861, 1877, 60 L.Ed.2d 447, 472 (1979). The Court noted that it had previously held that convicted prisoners do not forfeit all constitutional protections by reason of their conviction and confinement in prison. See Jones v. North Carolina Prisoners’ Labor Union, 433 U.S. 119, 129, 97 S.Ct. 2532, 2540, 53 L.Ed.2d 629, 640 (1977); Wolff v. McDonnell, 418 U.S. 539, 555-56, 94 S.Ct. 2963, 2974-75, 41 L.Ed.2d 935, 950-52 (1974). They may claim the protection of the Due Process Clause to prevent additional deprivation of life, liberty, or property without due process of law. See, e.g., Meachum v. Fano, 427 U.S. 215, 225, 96 S.Ct. 2532, 2538, 49 L.Ed.2d 451, 459 (1976); Wolff, 418 U.S. at 556, 94 S.Ct. at 2974, 41 L.Ed.2d at 951.
The Supreme Court further stated:
A fortiori, pretrial detainees, who have not been convicted of any crimes, retain .at least those constitutional rights that we have held are enjóyéd by convicted prisoners.
Bell, 441 U.S. at 545, 99 S.Ct. at 1877, 60 L.Ed.2d at 472; see also Perkins v. Grimes, 161 F.3d 1127, 1129 (8th Cir.1998) (pretrial detainees entitled to at least as much protection as a convicted inmate).
Brown has not been convicted of any crime; he is detained and incarcerated to ensure his appearance for trial solely on the legal principle that there is reasonable cause to believe he has committed a crime. Gerstein v. Pugh, 420 U.S. 103, 114, 95 S.Ct. 854, 863, 43 L.Ed.2d 54, 65 (1975). Although the presumption of innocence does not attach until trial, he is then entitled to it under the Constitution as a free person. Bell, 441 U.S. at 520, 99 S.Ct. at 1861, 60 L.Ed.2d at 447; see In re Win-ship, 397 U.S. 358, 363-64, 90 S.Ct. 1068, 1072, 25 L.Ed.2d 368, 375 (1970).
Prisoners possess a significant liberty interest in avoiding the unwanted administration of antipsychotic drugs under the Due Process Clause of the Fourteenth Amendment. Washington, 494 U.S. at 221-22, 110 S.Ct. at 1036, 108 L.Ed.2d at 197-98.
Although the evidence suggests that physical pain is minimal iri kidney dialysis treatment it can hardly be said, under these circumstances of unwanted treatment by Brown, that mental and emotional pain is not present. And, given that likelihood, has Brown been the recipient of punishment by the state;- in furthering its own interests?'
*434“Punishment” has been defined to include pain, suffering or confinement.
PUNISHMENT. In criminal law. Any pain, penalty, suffering, or confinement inflicted upon a person by the authority of the law and the judgment and sentence of a court, for some crime or offense committed by him, or for his omission of a duty enjoined by law.
Black’s Law Dictionary 1398 (4th ed.1951).
The Supreme Court in Bell considered a series of restrictions imposed on pretrial detainees, who were housed with convicted felons, in determining their liberty interests under the Fourteenth Amendment. These regulations by the jail officials included double bunking; restrictions on receipt by mail of food, personal items and books; and submission to strip searches, room searches, and body cavity searches. These measures were all found to be rationally related to the legitimate security concerns of the jail officials. As such, they did not constitute punishment of pretrial detainees that deprived them of their liberty interest without due process of law under the Constitution.
The same cannot be said of the State’s decision imposed upon Brown. Though establishing legal maxims, the Bell case is inapposite to Brown’s situation. The security problems addressed in Bell came from parties outside the jail who directed their actions to the pretrial detainees in jail. Brown’s desire to exercise his liberty right is passive, independent, and inherently nonthreatening. Contrasted to the physical restrictions addressed in Bell, the imposition of the State’s interests on Brown’s liberty interest is vastly more invasive. Brown has been denied the very essence of self-determination. He has been the recipient of punishment by the State including the physical pain of unwanted medical treatment and the mental and emotional pain underlying a decision of this magnitude.
In the instant case, the majority has fundamentally undervalued the liberty interest of the Fourteenth Amendment. At the same time it has recognized the State’s interests as supreme even though they are totally unsupported by the evidence. Regarding the state’s interest in preserving life, the Supreme Court quoted with approval the New York Court of Appeals’ statement that “ ‘no person or court should substitute its judgment as to what would be an acceptable quality of life for another.’ ” Cruzan, 497 U.S. at 275,110 S.Ct. at 2849, 111 L.Ed.2d at 239 (quoting In re Westchester County Med. Ctr. ex rel. O’Connor, 72 N.Y.2d 517, 534 N.Y.S.2d 886, 531 N.E.2d 607, 613 (1988)).
As to the interests of innocent third parties, there is no evidence on this matter. With respect to maintaining the integrity of the medical profession there is no evidence to indicate any effect. Finally, on the issue of maintaining prison security, order and discipline, the record is devoid of any evidence of danger or impediment to these concerns emanating from Brown’s expressed decision to exercise his constitutionally protected liberty interest. The majority’s belief that this is a weighty factor is supported not by facts or citable incidents of problems created by Brown, but only by the chief jailer’s concern about some residual effect causing “some fallout with some other inmates.” A never explained piece of nebulous evidence, at best.
Constitutional rights should not be shunted aside by such a frail reed of supposition.
I believe that the trial court carefully analyzed the law, properly assessed the factual circumstances presented and correctly decided this case. I would annul the writ of certiorari.
McGIVERIN, C.J., and CADY, JJ., join this dissent.