Court Opinion

ID: 9719939
Source: CourtListenerOpinion
Date Created: 2023-08-26 08:09:59.71231+00
Date Added: 2024-06-11T18:24:11.483948
License: Public Domain

CADY, Justice,
(dissenting).
I respectfully dissent. I agree with the legal principles set forth in the majority opinion, but disagree with the application of these principles to the facts of the case. *435The State has failed to show Brown’s constitutional right to refuse unwanted medical treatment must be taken from him to protect the security, order, and discipline of the jail.
A competent person has a constitutional right to refuse unwanted medical treatment. 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). Consequently, our government may not deprive an individual of this right without establishing an overriding state interest. See Winegard v. Oxberger,' 258 N.W.2d 847, 850 (Iowa 1977), cert, denied, 486 U.S. 905, 98 S.Ct. 2234, 56 L.Ed.2d 402 (1978). The majority has identified five state interests implicated by Brown’s exercise of his constitutional right, and concluded these interests outweigh the exercise of his right.
In considering the State’s interest, it must be recognized that Brown’s constitutional right to refuse unwanted medical treatment would, most assuredly, prevail over the competing interests of the State if he were not incarcerated in the county jail. This is because most of the interests of government identified by the majority have been considered, directly or indirectly, in recognizing the existence of the underlying constitutional right to refuse medical treatment. See Cruzan, 497 U.S. at 271, 110 S.Ct. at 2847-48, 111 L.Ed.2d at 237. Consequently, this is not a case of protecting life, preventing suicide, protecting innocent third parties, or maintaining the ethical integrity of the medical profession. These interests must generally give way to the individual right to refuse medical treatment. Id. at 278, 110 S.Ct. at 2851, 111 L.Ed.2d at 241.
Instead, what really drives this case is the State’s interests in maintaining jail security, order, and discipline. While these are legitimate interests, I do not believe the State showed they would be sufficiently compromised to support the denial of a recognized constitutional right.
A prison regulation which impinges on a constitutional right of a prisoner is valid if the regulation “is reasonably related to legitimate penological interests.” Turner v. Safley, 482 U.S. 78, 89, 107 S.Ct. 2254, 2261, 96 L.Ed.2d 64, 79 (1987). Although this is not a stringent test, it nevertheless requires a reasonable connection between the regulation -imposed by the prison and the penological interest at stake. Id. at 93, 107 S.Ct. at 2264, 96 L.Ed.2d at 82. Regulations based on “exaggerated” concerns are not reasonably related to any state interest. Id. at 97-98, 107 S.Ct. at 2266, 96 L.Ed.2d at 84. The mere possibility of an adverse impact upon a governmental interest is insufficient to subordinate a constitutional right. See Turley v. Adel Community Sch. Dist., 322 F.Supp. 402, 408 (S.D.Iowa 1971). Constitutional rights are too important to be denied based on supposition and unfounded fears.
The State offered two penological intér-ests to support its mandate that Brown receive dialysis. First, it claimed other inmates would attempt to follow Brown’s actions as a way to be released from jail. Second, it claimed more staff would be needed to supervise Brown once his physical condition began to deteriorate. Giving deference to the jailer’s expertise and experience, the majority concludes these interests support the denial of Brown’s constitutional right.
Although manipulative behavior and supervision are legitimate general penological concerns, they are not in this case. We should not accept the expressed concerns of the State without subjecting them to some scrutiny that reveals a reasonable necessity for the particular regulation.
The first claim is an exaggerated response by the jailer. There is no suggestion that authorities would release Brown from his pretrial detention if his decision to refuse medical treatment was honored. To the contrary, the evidence indicated Brown would simply be transported to a hospital once his medical condition became critical. Not only would any manipulative *436motive be unsuccessful, but the planned response by the jailer would not give other inmates an incentive to copy Brown. This is not a case of an inmate attempting to manipulate the system to obtain some advantage. Brown simply wants to die by discontinuing his medical treatment. He would not be engaging in conduct others would be inclined to follow.
The second concern is also exaggerated in this case. Although Brown may require some additional supervision for a limited period of time if he discontinued his dialysis, it is unrealistic to claim this minimal imposition on prison staff would undermine prison security, order, or discipline any more than the current supervision Brown receives.
Prisoners are not divested of their constitutional rights once they become imprisoned. Williams v. State, 878 N.W.2d 894, 897 (Iowa 1985). Brown has a recognized constitutional right to refuse unwanted medical treatment. Cruzan, 497 U.S. at 278, 110 S.Ct. at 2851, 111 L.Ed.2d at 241. Without a compelling and overriding interest, our government should not deprive citizens of their constitutional rights. Constitutional rights must not become so confined by government restrictions that they begin to exist in principle more than fact. See Tinker v. Des Moines Ind. Community Sch. Dist., 393 U.S. 503, 508-09, 89 S.Ct. 733, 737, 21 L.Ed.2d 731, 739 (1969).
McGIVERIN, C.J., and SNELL, JJ., join this dissent.