Court Opinion

ID: 9730431
Source: CourtListenerOpinion
Date Created: 2023-08-26 15:12:04.865772+00
Date Added: 2024-06-11T18:26:06.424908
License: Public Domain

O’Connor, J.
(dissenting, with whom Lynch, J., joins). The judge determined, and the court affirms, that, “were Doe competent, she would wish to ‘go in peace.’ ” Ante at 525. As I did in Brophy v. New England Sinai Hosp., Inc., 398 Mass. 417, 448-453 (1986), and Norwood Hosp. v. Munoz, 409 Mass. 116, 131-133 (1991), I protest the court’s legal embrace of suicide — and beyond. As recently as 1980, the court stated that, “a competent person has a general right to refuse medical treatment in appropriate circumstances, to be determined by balancing the individual interest against countervailing State interests, particularly the State interest in the preservation of life” (emphasis added). Matter of Spring, 380 Mass. 629, 634 (1980). See also Superintendent of Belchertown State Sch. v. Saikewicz, 373 Mass. 728, 745 (1977). More recently, however, and ominously, the limiting references to appropriate circumstances and State interests have disappeared from the court’s definition of the right to refuse life-sustaining treatment. In the present case, the court describes the right this way: “Competent individuals have the right to refuse medical treatment. Norwood Hosp. v. Munoz, 409 Mass. 116, 122 (1991). They have a concomitant right to discontinue medical treatment. Brophy [, supra at] 438.” Ante at 517. Then, in order to make clear that the new formulation of the rule is indeed designed to grant competent individuals an unqualified and absolute right of self *531determination, the court states in a conclusory fashion: “The Commonwealth’s interest in preserving life is strongest when it is attempting to protect its citizens from abuse or infringement of their rights. Where, however, as here, the appellees are striving to vindicate Doe’s right to refuse invasive treatment, Doe’s ‘right to self determination must prevail over the State’s interest in preserving life for all.’ ” Ante at 521. The court’s position is clear: Although the State may have a legitimate interest in supporting a competent individual’s election to live, it has no legitimate interest in opposing or frustrating anyone’s choice to die. The court reaffirms what it declared in Brophy, supra, and Munoz, supra, despite its disclaimer in those cases, that a competent individual has a legal right in this Commonwealth to commit suicide, and that others have a right to assist him or her in that effort.
Suicide, the purposeful termination of one’s own life, is no less suicide when death is accomplished by inaction than when an affirmative act is employed as the agent of death. As Justice Scalia wrote in Cruzan v. Director, Mo. Dep’t of Health, 110 S. Ct. 2841, 2861 (1990) (Scalia, J., concurring), “ [i]t would not make much sense to say that one may not kill oneself by walking into the sea, but may sit on the beach until submerged by the incoming tide. . . . Starving oneself to death is no different from putting a gun to one’s temple as far as the common-law definition of suicide is concerned; the cause of death in both cases is the suicide’s conscious decision to ‘put an end to his own existence.’ 4 Blackstone, [Commentaries] at *189.” Similarly^ there is no valid moral or legal distinction between active and passive euthanasia.
I would agree that the law should recognize a competent person’s right to refuse or withdraw medical treatment when that choice is not motivated by a desire to die but, instead, is reasonably motivated by a desire to avoid procedures that are in themselves, and not simply because they prolong life, physically or emotionally painful. Suicide, however, is a different matter. Society’s respect for the value of every human life without reference to its condition, the cornerstone of *532American law, is inconsistent with a State’s recognition of a legal right to commit suicide, assist suicide, or engage in voluntary euthanasia (mercy killing in accordance with the wishes of the suffering person). “The life of those to whom life has become a burden — of those who are hopelessly diseased or fatally wounded — nay, even the lives of criminals condemned to death, are under the protection of the law, equally as the lives of those who are in the full tide of life’s enjoyment, and anxious to continue to live.” Cruzan, supra at 2860 (Scalia, J., concurring), quoting Blackburn v. State, 23 Ohio St. 146, 163 (1873). Recognition of the dignity of human life demands resistance, rather than concession, to the real or imaginary death wishes of those who are afflicted with pain, depression, a sense of personal worthlessness, or a sense of burdensomeness to others A humane society provides support of every kind, including moral support, to those who are burdened in order that they may live, not “go,” as the Probate Court judge, with this court’s approval, would have it, ante at 525, in “peace.” No “legal system” is worthy of that appellation unless its primary function is to protect the most vulnerable members of society. It follows that, in the absence of otherwise compelling legislation, no court should recognize a legal right to commit suicide, whether by action (e.g., lethal injection) or by inaction (e.g., withdrawal of nutrition and hydration, or withdrawal of antibiotic medication to treat pneumonia). Nor should any court recognize a corresponding right to assist in suicide or to engage in the closely related practice of voluntary euthanasia.
Can it reasonably be doubted that legal acceptance of suicide, assisted suicide, and voluntary euthanasia presents a serious risk that acceptance of involuntary euthanasia (mercy killing not chosen by the affected individual) is soon to follow? Today’s decision is most instructive. Indeed, it is a case in point. By a process of substituted judgment, a Probate and Family Court judge, affirmed by this court, attributed to Jane Doe, a woman who has been profoundly retarded since infancy and exists in a persistent vegetative state, a choice to discontinue the tube-feeding and hydration necessary to her *533survival. This attribution of choice was made and affirmed although Doe, never having had an ability to commit volitional acts, and showing no response to stimuli calculated to cause pain in a conscious individual, could not possibly have sought to be free from physically or emotionally painful treatment. Nevertheless, the choice made for, and attributed to, Doe is said to have been predicated on the judge’s decision, based on the preponderance of the evidence, that Jane Doe, were she competent, would have preferred death over life as she was living it, and would have requested that her choice to end her life be honored. On the basis of an assessment of the quality of life accessible to Doe, the judge authorized the withholding of food and water in order that Doe, who actually had no say in the matter, might “go in peace.” If this is not involuntary euthanasia, or worse, it is hard to know what is.
The court states: “We recognize that in situations in which there is an attempt to use substituted judgment for a never-competent person, it is a legal fiction.” Ante at 518. Black’s Law Dictionary 894 (6th ed. 1990), defines “legal fiction” this way: “Assumption of fact made by court as basis for deciding a legal question. A situation contrived by the law to permit a court to dispose of a matter, though it need not be created improperly; e.g. fiction of lost grant as basis for title by adverse possession.” Doe’s choice to discontinue nourishment and hydration is indeed a contrivance. By the nature of her illness, she is without pain; “she is without emotion of any sort.” Ante at 516. Therefore, nothing related to her own best interests would suggest to her, were she competent, that it is time for her to go in peace. And even if she were hurting, how can anyone say, applying even the minimal preponderance of the evidence standard of proof, that it has been established that Doe, if she were competent, would choose death over life? Almost everyone has known someone who has tenaciously clung to life against all odds despite immense anguish and pain. There are many possible explanations for that in addition to mankind’s innate instinct to survive. For example, were she competent, Jane Doe might consider her *534life a precious gift from God to be nourished, not rejected. If, indeed, the court’s goal is to protect Jane Doe’s liberty interest in individual choice, the court should recognize that “[individual choice is determined not by the vote of the majority but by the complexities of the singular situation viewed from the unique perspective of the person called on to make the decision.” Saikewicz, supra at 747. It obviously is impossible to know what never-competent Jane Doe’s unique perspective would have been or what life and death choice she would have made had she been competent. Perhaps she would have exercised the most fundamental right anyone has — the foremost right protected by the Federal and State Constitutions — the right to life. By imposing a death, rather than life, choice on Jane Doe, it is arguable that the court violates that right. Surely, by imposing a judicial choice, the court violates the very value it professes to espouse: the dignity of incompetent persons and their concomitant right to self determination.
The court’s attempt to use substituted judgment for a never-competent person is not the only fiction to be found in its opinion. There are several others, but I shall focus on only three. The first of these is that the court’s approval of the withdrawal of Jane Doe’s nutrition and hydration is given for Jane Doe’s benefit. That leads me to ask how she benefits from an early death. She is not burdened by life. She need not “go” to be in peace. For all that appears, with food and drink and care she can “stay” in peace. Any benefit derived from terminating Jane Doe’s life is derived by someone else.
The second fiction I wish to address concerns causation. Quoting Brophy, supra at 439, the court claims that “death which occurs after the removal of life sustaining systems is from natural causes, neither set in motion nor intended by the patient.” Ante at 522. The court states, with obvious approval, that “[t] he judge determined that Canavan’s disease, not the removal of the feeding and hydration tube, would be the death producing agent if the tube is removed.” Ante at 522-523. That surely is “[a] situation contrived by the law to permit a court to dispose of a matter.” The court employs a *535device, a pretense, contrived for the purpose of authorizing the termination of Jane Doe’s life. It is clear that, but for removal or non-use of the nasoduodenal tube, Jane Doe will live for the indefinite, perhaps considerable, future. Without it she will promptly die. That is proximate causation according to any recognized definition of that term.
The fiction as to causation is especially disturbing because its apparent purpose is to give support to the further fiction, expressed elsewhere in the court’s opinion, that the feeding and hydration of Jane Doe may be discontinued without anyone being responsible for her death. Doe will not be responsible, says the court, because she is incapable of choice (“Doe has no ability to commit a volitional act.” Ante at 522). Others will not be responsible because they are only vindicating Jane Doe’s choice, not exercising their own. Ante at 522. In any event, the court says, Doe’s death will result only from natural causes and not from starvation due to withdrawal of the nasoduodenal tube.
I am not insensitive to the immense burden carried by Jane Doe’s family for a long time. Furthermore, I do not underestimate either the complexity of questions that may arise as a result of scientific advancements enabling the prolongation of life, nor am I unaware of associated anguish and stress. Lastly, I do not intend by the expression of my views in this opinion to demonstrate disrespect for those with whom I disagree. However, I must make very clear that I view the court’s decision and its reasoning today as seriously wrong. The implications of this decision are frightening, not only for Jane Doe but for others similarly situated, such as the institutionalized, the elderly, and children with “defects” who are too young to make decisions for themselves. I would reverse the judge’s order.