Court Opinion

ID: 9627141
Source: CourtListenerOpinion
Date Created: 2023-08-22 08:35:41.40201+00
Date Added: 2024-06-11T15:30:36.770934
License: Public Domain

Justice MULLARKEY,
dissenting:
I respectfully dissent.
I agree with the majority’s conclusion that In re A. W., 637 P.2d 366 (Colo.1981), set the appropriate procedure for the trial court to follow in deciding whether to order *825the sterilization of La Vista Romero. In re A.W. provides a clear list of steps which should be followed by the district court in making such determinations. Prior to deciding the primary issue of whether to order sterilization of an incapacitated person, the district court must make the following preliminary determinations: First, the trial judge should talk to the individual in order to observe the person’s physical and mental conditions; along these lines, the individual’s wishes are relevant although not conclusive and should be weighed heavily. Second, the district court must determine by clear and convincing evidence that the person is incapable of making a decision about sterilization and that the person’s capacity is unlikely to improve in the future. Third, the person must be proven capable of reproduction. Once a district court makes the preliminary determinations, the court must find by clear and convincing evidence that sterilization is medically essential. Id., at 375.
The majority adopts the following test for determining an individual’s capacity to make a decision about sterilization:
An individual should be deemed competent to grant or withhold consent [to sterilization] if the individual understands the nature of the district court’s proceedings, the relationship between sexual activity and reproduction and the consequences of the sterilization procedure.
Maj. op. at 823.
Shirley Harvey, Romero’s mother and guardian, argues that the test of competency in this context requires an inquiry into the individual’s capacity to understand the risks of pregnancy and childbirth. Without discussion, the majority apparently rejects Harvey’s argument and states that the individual need not “comprehend all the risks of pregnancy and childbirth in order to be considered competent to grant or withhold consent to sterilization.” Maj. op. at 823.
. In its application of the test, however, the majority addresses Romero’s understanding of the risks of pregnancy and childbirth. The majority interprets the record as supporting the conclusion that Romero is aware of and understands the risks of pregnancy and childbirth which she is willing to undertake in the future, and it notes that Romero’s psychiatrist, Dr. Paula Trautner, “did not state that Ms. Romero is unaware of those risks.” The majority supports its conclusion that Romero is aware and understands the risks of pregnancy by her statement that she would like to have a child when her diabetes is cured. The majority’s analysis of Romero’s understanding of the risks of pregnancy and childbirth shows me that such awareness is an inherent part of determining the individual’s understanding of “the consequences of sterilization,” which is part of the majority’s test. A sexually active, fertile woman assumes the - risks of becoming pregnant and bearing a child, and a woman’s capacity to understand such risks as applied to herself, therefore, should enter into the court’s assessment of her ability to make a sterilization decision.
The record as a whole does not support the conclusion that Romero was able to understand or actually understood the risks which pregnancy and childbirth posed to her because of her age and her severe diabetic condition. Dr. Trautner testified as to Romero’s understanding of the physical consequences of pregnancy and said that “[bjasically her response is she had babies before and she can do it again and that there should not be any major problems. So, in other words, she does not have a good understanding of how the pregnancy would affect the diabetes at this point.” Furthermore, when Romero was on the stand she testified as follows:
Q. Do you understand if you got pregnant that it might be risky for your health?
A. No.
Q. Because you’ve got diabetes it might make it unsafe for you to be pregnant?
A. It didn’t hurt me the first time. I mean the second time is what I should say.
Q. Even if there was a risk would you want to get pregnant and have another baby?
*826A. Not at the nursing home, no.
Q. What about if you are out of the nursing home? What if you were married to Dean?
A. Yes, I would want a baby then.
Q. Even though it would be risky for you?
A. Yes. I’ll take that chance.
Later the trial judge questioned Romero about her understanding of the risks involved in pregnancy and she testified as follows:
Q. You’ve told us that you want to have a child.
A. Yes.
Q. And the doctors have been telling me here today in the hearing that that would be very dangerous for you to do. In fact, it could be threatening to your health, or even to your life. Did you hear that testimony?
A. Yes.
Q. Does that make you feel maybe you should be more cautious or maybe you shouldn’t have a baby because of what they have said?
A. No.
Q. Why is that?
A. Because I want one bad enough.
Q. Realizing that it could even kill you?
A. Yes, sir.
It appears that Romero could not connect her diabetic condition with the risks of pregnancy and childbirth. Romero asserted that pregnancy would “not be bad" for her and that her past difficulty in childbirth and the premature birth of her second child were not a result of her diabetes but rather due to her smoking. She also indicated that her diabetic condition would not be a serious limitation on her being pregnant because in the meantime a cure would be found for diabetes.
In my opinion, Romero’s statements indicate that she lacks the capacity to understand the risks involved in pregnancy. Her responses to questions imply that she has an illusory view of her disease and its implications. The attorneys and medical experts at the hearing repeatedly emphasized the dangers that pregnancy and childbirth entailed, but her responses indicated that she could not relate the dangers to herself and her particular situation. Although she did state that she would like to have a child when her diabetes was cured, the context of her statement indicated her unrealistic, and perhaps wishful, assessment of her situation.
An evaluation of Romero’s capacity to understand the risks of pregnancy should include consideration of whether she could comprehend the risks at a future date when she was not in the courtroom being reminded constantly of the risks. Dr. Trautner testified that Romero is subject to rapid mood changes and has difficulty thinking abstractly or in terms of future consequences. Dr. Trautner’s testimony is, thus, relevant to an evaluation of Romero’s capacity to understand the risks.
I would include the individual’s capacity to understand the risks of pregnancy and childbirth in the test for determining one’s competence to make a decision regarding sterilization. Capacity to understand, not perfect knowledge, should be the key. As the majority correctly points out at page 822, competency must be determined in context and an individual is not necessarily incompetent for all purposes. When sterilization is the issue, it is not enough for the incapacitated person to understand the nature of the district court’s proceedings, the relationship between sexual activity and reproduction and the consequences of the sterilization procedure. The individual also must be able to understand the risks of childbirth and pregnancy in order to decide whether to be sterilized.
I also dissent from the majority's disposition of this case. This is a significant issue which this court addresses for the first time. The majority develops a test which was not available when the case was tried. An appellate court is in a poor position to evaluate Romero’s testimony and demeanor which obviously are critical in determining her competence. The best course is to remand the case for retrial so that relevant evidence may be presented and the trial *827court can make the initial determination of Romero’s competency under the new standard-
ERICKSON and ROVIRA, JJ., join in this dissent.