Court Opinion

ID: 9715775
Source: CourtListenerOpinion
Date Created: 2023-08-26 06:13:57.696761+00
Date Added: 2024-06-11T18:23:38.060943
License: Public Domain

Davidson, J.,

dissenting:

I agree with the majority that circuit courts "have subject matter jurisdiction to consider a petition for an order authorizing a guardian to consent to the sterilization of an incompetent minor.” I further agree with the majority that in determining whether such a petition is in the best interests of the incompetent minor, it is essential that the circuit court take into account and be guided by certain minimal standards. However, I do not agree with certain aspects of the standard adopted by the majority relating to the determination of what is in the best interests of the incompetent minor because that standard does not include some factors that should be considered by a trial court. In my view, the trial court must not only consider the factors articulated by the *719majority, but additionally must also consider: 1) whether the incompetent minor presently lacks an understanding of the reproduction process, including menstruation and pregnancy, and will continue to lack that understanding in the future; 2) whether the incompetent minor is presently unable to care for a child and will continue to be unable to do so in the future; and 3) whether the incompetent minor’s risk of psychological trauma or damage resulting from pregnancy outweighs the risk of such trauma or damage resulting from a sterilization procedure.
More important, by requiring the trial court to find "by clear and convincing evidence that the requested operative procedure is medically necessary to preserve the life or physical or mental health of the incompetent minor,” the majority places undue and improper emphasis upon the factor of medical necessity. In so doing, the majority makes the factor of medical necessity controlling in determining whether a petition to authorize a guardian to consent to sterilization of an incompetent minor is in the best interests of the incompetent minor. For the reasons set forth below, I would not treat this factor as controlling, but rather would regard it as one of the many factors to be considered in determining whether sterilization is in the best interests of the incompetent minor.
In my view, an individual has a constitutional right to privacy including the right to voluntary sterilization. As long ago as 1942, in Skinner v. Oklahoma, 316 U.S. 535, 541, 62 S.Ct. 1110, 1113 (1942), the United States Supreme Court held that a state could not sterilize a "habitual criminal.” Thus, it recognized procreation as a fundamental right. In Griswold v. Connecticut, 381 U.S. 479, 485-86, 85 S.Ct. 1678, 1682 (1965), that Court held that the state could not interfere with a married person’s right to use contraceptives. Thus, the Supreme Court established a constitutionally protected right to privacy including the right to make personal decisions relating to procreation and contraception. In Eisenstadt v. Baird, 405 U.S. 438, 92 S.Ct. 1029 (1972), the Supreme Court extended the right to use contraceptives to unmarried persons. There, the Court said:
*720"If the right of privacy means anything, it is the right of the individual, married or single, to be free from unwarranted governmental intrusion into matters so fundamentally affecting a person as the decision whether to bear or beget a child.” Eisenstadt, 405 U.S. at 453, 92 S.Ct. at 1038 (emphasis in original) (citations omitted).
Similarly in Carey v. Population Services International, 431 U.S. 678, 97 S. Ct. 2010 (1977), the Supreme Court extended the right to use contraceptives to minors. There, the Court explicitly reiterated that the constitutional right to privacy includes not only an adult’s but also a minor’s right to determine whether to procreate or prevent conception. The Court said:
"The decision whether or not to beget or bear a child is at the very heart of this cluster of constitutionally protected choices.
"Of particular significance to the decision of this case, the right to privacy in connection with decisions affecting procreation extends to minors as well as to adults.” Carey, 431 U.S. at 685, 693, 97 S.Ct. at 2016, 2020.
Thus, the Supreme Court established that minors as well as adults have a constitutionally protected right to privacy that includes both the fundamental right to procreate established in Skinner and the fundamental right to prevent conception recognized in Griswold and Eisenstadt, and, therefore, that there is a constitutionally protected right to individual control over procreation decisions.
In Roe v. Wade, 410 U.S. 113, 162-65, 93 S.Ct. 705, 731-32 (1973), the Supreme Court held that the state could not interfere with an adult’s right to abortion during the first trimester of pregnancy. Thus, the Supreme Court established that the constitutionally protected right to privacy includes the right to make personal decisions relating to procreation even after conception.
*721Subsequently, the Supreme Court extended the right to abortion to minors. H.L. v. Matheson, 450 U.S. 398, 411, 101 S.Ct. 1164, 1172 (1981); Bellotti v. Baird, 443 U.S. 622, 651, 99 S.Ct. 3035, 3052 (1979); Planned Parenthood of Central Missouri v. Danforth, 428 U.S. 52, 74, 96 S.Ct. 2831, 2843 (1976). In Planned Parenthood of Central Missouri v. Danforth, 428 U.S. 52, 96 S.Ct. 2831 (1976), the Supreme Court held that a minor had a constitutionally protected right to obtain an abortion during the first trimester of pregnancy without her parents’ consent. Recognizing that "minors, as well as adults, are protected by the Constitution and possess constitutional rights,” the Court said:
"Just as with the requirement of consent from the spouse, so here, the State does not have the constitutional authority to give a third party an absolute, and possibly arbitrary, veto over the decision of the physician and his patient to terminate the patient’s pregnancy, regardless of the reason for withholding the consent.” Danforth, 428 U.S. at 74, 96 S.Ct. at 2843.
Thus, the Supreme Court established that only the minor, in consultation with her physician, had the right to make procreation decisions concerning herself, and that the minor’s determination was not subject to veto by the state or any other third party.
A review of the recent cases demonstrates that without deviation, the Supreme Court has protected the rights of adults and minors to decide for themselves both before and after conception whether to bear children. I recognize that the Supreme Court has not yet defined the full scope of the right to privacy and has not yet determined whether there is a constitutionally protected right to sterilization. Yet, in my view, the rationale underlying the Supreme Court’s procreation, contraception, and abortion cases inevitably leads to the conclusion that adults and minors have the fundamental right not only to decide to bear children but also to decide not to bear children, and to make that decision permanent by voluntarily undergoing sterilization. Courts *722in other jurisdictions agree. E.g., Hathaway v. Worcester, 475 F.2d 701, 705 (1st Cir. 1973); Ruby v. Massey, 452 F.Supp. 361, 366, 368 (D. Conn. 1978); Peck v. Califano, 454 F.Supp. 484, 486-87 (C.D.Utah 1977); In re A. W., Colo., 637 P.2d 366, 369 (1981); In re Moe, 385 Mass. 555, 432 N.E.2d 712, 719-20 (1982); In re Grady, 85 N.J. 235, 247, 426 A.2d 467, 473 (1981).
Manifestly, the procreation alternatives available to competent adults and minors should also extend to individuals who are not mentally competent to make the choice themselves. The inability of incompetent individuals to choose should not result in the loss of their constitutionally protected rights. I agree with courts in those states that have determined that a trial court should substitute its judgment for that of the incompetent minor in order to preserve the fundamental rights of the incompetent minor and, therefore, to accord maximum protection to the incompetent minor’s best interests.
The rationale underlying the doctrine of substituted judgment was recently expressed by the Supreme Judicial Court of Massachusetts in In re Moe, 385 Mass. 555, 432 N.E.2d 712 (1982). There, the Court said:
"In utilizing the doctrine of substituted judgment, this court seeks to maintain the integrity of the incompetent person by giving the individual a forum in which his or her rights may be exercised. The court dons 'the mental mantle of the incompetent’ and substitutes itself as nearly as possible for the individual in the decision making process. In utilizing the doctrine the court does not decide what is necessarily the best decision but rather what decision would be made by the incompetent person if he or she were competent.
To speak solely in terms of the 'best interests’ of the ward, or of the State’s interest, is to obscure the fundamental issue: Is the State to impose a solution on an incompetent based on external criteria, or is *723it to seek to protect and implement the individual’s personal rights and integrity? We reject the former possibility. Each approach has its own difficulties, but the use of the doctrine of substituted judgment promotes best the interests of the individual, no matter how difficult the task involved may be.” In re Moe, Mass., 432 N.E.2d at 720 (citations omitted) (emphasis added).
Thus, under the doctrine of substituted judgment, in determining whether to authorize sterilization, the trial court must not be concerned solely with objective criteria of what is in the best interests of the incompetent minor, but rather must place primary emphasis upon the decision that would be made by the incompetent minor if he or she were competent. Only by so doing can the incompetent minor’s personal fundamental rights be fully protected and, therefore, the incompetent minor’s best interests be fully preserved.
The difficulty inherent in the majority’s establishment of "medical necessity” as a controlling factor in determining whether to authorize sterilization is that a trial court is compelled to place primary emphasis on a single objective standard irrespective of the decision that the incompetent minor would make if he or she were competent. In my view, treating medical necessity as a controlling factor results in an unacceptable degree of interference with an incompetent minor’s right to make decisions concerning sterilization because such a controlling factor might well prevent an individual who would wish to be sterilized if competent from being sterilized.
A minor’s constitutionally protected right to decide not to bear a child is to be made by the minor in consultation with her physician and is not subject to veto by the state or any third party. Danforth, 428 U.S. at 74, 96 S.Ct. at 2843. A competent minor, in consultation with her physician, may elect a procreative choice that is not a medical necessity. Such a choice is unavailable to an incompetent minor under the standard of medical necessity established by the major*724ity because not even the trial court, substituting its judgment for that of the incompetent minor, can authorize a sterilization that is not a medical necessity. Under the standard established by the majority, a decision to be sterilized that cannot be made by the incompetent minor in consultation with her physician also cannot be made for her by-the trial court in consultation with her physician, but rather is made for her solely by her physician on the basis of medical necessity. In essence, under the medical necessity standard, the physician is accorded an absolute veto over the decision to be sterilized. All of the other factors considered by the trial court are irrelevant.
In my view, the majority’s medical necessity standard substantially interferes with the protection of an incompetent minor’s fundamental rights, and thus the best interests of the incompetent minor are not fully protected. Of the six states that have established factors to be considered in determining whether to authorize the sterilization of an incompetent minor, only one, Colorado, has determined that medical necessity is a controlling factor. In re A. W., Colo., 637 P.2d at 375. Courts in two jurisdictions have explicitly rejected the notion that necessity be regarded as a controlling factor. In re Moe, 385 Mass, at n.10, 432 N.E.2d at 722 n. 10; In re Grady, 85 N.J. at 263 & 263 n.9, 426 A.2d at 481 & 481-82 n.9.
I am persuaded that the rights of an incompetent minor to make a free choice concerning procreation is most effectively protected if medical necessity for sterilization is regarded as but one factor to be considered in determining what is in the best interests of the incompetent minor. Accordingly, to this extent I respectfully dissent.
Finally, even if I were to assume that the standards established by the majority were appropriate, I would not agree with the majority’s affirmance in this case. The majority holds that the trial court erred in applying the "demonstrated need” formulation contained in Maryland Code (1974, 1981 Cum. Supp.) § 13-708 of the Estates and Trusts Article, and for the first time establishes appropriate stan*725dards to be employed by trial courts in determining when to authorize the sterilization of an incompetent minor. Nevertheless, the majority chooses not to remand this case to the trial court for the purpose of allowing the parties to present additional evidence required by the newly enunciated standards and for the purpose of allowing the trial court to apply those standards in making the requisite findings. Under these circumstances, the majority’s action in affirming rather than reversing and remanding does not comport with my sense of fairness. Thus, even if I agreed with the majority in all other respects, I would reverse and remand for further proceedings in order to advance the purposes of justice. Md. Rule 871. Accordingly, I respectfully dissent.