An interesting opinion from Maryland’s highest court just handed down yesterday, Stouffer v. Reid. An excerpt:
The respondent, Troy Reid …, an adult male, was committed to the custody of the Commissioner of Correction in 1995 to serve a forty year sentence. Reid’s medical history while in the institution revealed a diagnosis of high blood pressure, human immunodeficiency virus and end-stage renal disease. In July 2007, prison medical personnel diagnosed Reid with end-stage renal disease and prescribed the application of kidney dialysis three times per week. Initially, Reid consented to the dialysis treatment; however, even though he understood the medical consequences of ceasing dialysis (serious bodily injury and even death), he eventually requested that all treatment be terminated. As a result of his refusal to submit to kidney dialysis in April 2008, the petitioner, J. Michael Stouffer, Commissioner of Correction …, filed a complaint … seeking declaratory and injunctive relief to compel Reid to submit to kidney dialysis and medical treatment that medical professionals had determined was necessary.This case presents the question of whether the Commissioner presented sufficient evidence to override a competent adult inmate’s right to object to life-sustaining medical treatment. We shall hold that, under the circumstances of the present case, the Commissioner’s non-specific claim of preservation of life, safety, and security was insufficient to demonstrate that Reid’s refusal of medical treatment would cause a disruption or impact safety in the institution, or endanger the ethics of the medical profession.
Tim says:
I even learned a new word, “penological.” It apparently means:
April 20, 2010, 6:43 pmhattio says:
So,
April 20, 2010, 8:36 pmIf you are a prisonor who is convicted of a crime, and therefore have lost some of your rights, you can refuse medical treatment. However, if you are involuntarily committed due to mental illness you can’t? Even though you (theoretically) haven’t lost any rights except your second amendment rights?
neurodoc says:
Hard to imagine a different result. But what if instead of a prisoner serving what amounts to a life sentence, it was someone awaiting execution on death row? And instead of medical conditions that if untreated would likely foreshorten his life considerably, it was a medical condition that would likely produce death in relatively short order if untreated, e.g., serious cardiac arrhythmia predisposing to sudden death if not treated, maybe with a pacemaker? If the death row prisoner refused treatment, could the warden force treatment upon the prisoner, so he would live until the date appointed for his execution? There was a case like that in CA with a prisoner with heart disease asking that he not be resuscitated should he experience a cardiac arrest and the warden saying no way, the prisoner was not going to cheat the executioner if he the warden could prevent him from doing so. Don’t think it made it to court, so don’t know whether a prisoner on death row has lesser rights in this regard than other prisoners or not.
I will read this decision with interest, looking to see what legal light it might shed on my hypothetical. If Reid had been a prisoner condemned to death who would refuse medical treatment in the hope of dying a “natural” death as opposed to the one the state would cause him at some later time, would the court still have found that he had the right to refuse treatment, and thus avoid execution by the state in the same way that suicide would avoid it?
(Professor Volokh, I actually put my hypothetical to you a few years ago after I learned of that case, but you begged off. Care to venture a from the hip answer now in light of Stouffer v Reid?)
April 20, 2010, 8:43 pmSteve says:
However, if you are involuntarily committed due to mental illness you can’t? Even though you (theoretically) haven’t lost any rights except your second amendment rights?
Sure, if you’re not competent you can lose lots of rights, even if you’re not in state custody.
April 20, 2010, 8:44 pmNI says:
It seems to me the state’s interest would be in having him die as early as possible so as to have one fewer prisoner to feed, clothe and house. What am I missing?
April 20, 2010, 9:14 pmLaura(southernxyl) says:
NI, by your logic it would be in the state’s interest to arm the prisoners and turn them out in the yard together in hopes that they’d kill each other off.
April 20, 2010, 9:41 pmneurodoc says:
People are involuntarily committed because they are either a danger to themselves or to others, and not competent to act in their own self-interest. It troubles you that they should be medicated for their benefit rather than simply confined and left in their miserable, often anguished state? (Somewhat different set of medical and legal considerations when tney face criminal charges and are medicated against their wishes so that they will be competent to stand trial.)
April 20, 2010, 9:53 pmbyomtov says:
This decision seems obviously correct to me.
April 20, 2010, 9:57 pmMalvolio says:
Didn’t you see Kentucky Fried Movie? The scene where the prosecutor waves a dildo at a witness and asks, “Are you aware of the penal codes in this state?”
April 20, 2010, 9:58 pmreadery says:
Why bother with capital punishment?
Just hold them in solitary until they refuse nutrition and hydration. Perhaps a few subtle or not-too subtle messages that this would be best for all concerned might help.
April 20, 2010, 10:02 pmneurodoc says:
NI may not be expressing a very humanistic point of view, but then humanism does not know its greatest expression in prisons. That said, it doesn’t follow logically, though, that NI should see it as permissible for the state “to arm the prisoners and turn them out in the yard together in hopes that they’d kill each other off.” States may not do a very good job of protecting prisoners from one another, but it is certainly their moral and legal responsibility to do so to the fullest extent possible.
April 20, 2010, 10:04 pmTatil says:
If it is a voluntary program and inmates are sentenced to life without parole or something like let’s say 60 years, you might be onto something. Afterall, there is a huge prison overcrowding problem in California. :)
April 20, 2010, 10:31 pmMichael says:
That is not sot so. A commitment only specifies that you be subject to the ordinary supervision of a mental hospital for a certain period of time. Specific medical treatment is not ordinary supervision and would still be at issue. As a side note, peritoneal dialysis has been found to be a more agreeable treatment for ESRD patients.
April 20, 2010, 10:41 pmneurodoc says:
Maybe I was wrong in saying “humanism does not know its greatest expression in prisons.” Maryland’s Commissioner of Corrections is concerned lest allowing a prisoner to refuse medical treatment and experience the health consequences of their decision, including a predictably hastened death, increase “angst” within the general prison population that he appealed all the way up to the state’s highest court in an attempt to force treatment upon the prisoner. Who knew prison communities from the top to the bottom were this caring and respectful of life.
Thankfully, Maryland’s courts weren’t as stupid in Reid as those Iowa courts in which saw it as an impermissible afront to the medical profession to allow a prisoner to go against medical advice.
April 20, 2010, 10:57 pmneurodoc says:
…those Iowa courts in Polk which saw it as an impermissible afront to the medical profession to allow a prisoner to go against medical advice.
April 20, 2010, 11:14 pmDave N. says:
It appears to me that the courts reached the right decision. Prisoners lose many, many rights — but it seems to me that should not include whether they can refuse medical treatment.
April 21, 2010, 2:35 amSmooth, like a Rhapsody says:
two questions occur to me:
April 21, 2010, 8:30 amcould the legislature pass a statute that would survive SDP/constitutional review that made the warden the medical proxy of all prisoners?;
and, second, does the analysis here change if the prisoner is afflicted with a communicable disease, like typhus or ebola?
Laura(southernxyl) says:
Neurodoc, NI said, “What am I missing?” I somehow didn’t think it would be productive to answer “a heart, a conscience, and basic humanity”.
April 21, 2010, 9:25 amParatrooperJJ says:
Refusal of medical treatment is a basic human right. The correct desicion was made.
April 21, 2010, 10:48 amKen Arromdee says:
Being free is also a basic human right and prisoners are not free. The whole idea of prison is that you lose your rights.
April 21, 2010, 10:52 amUrso says:
OK, so access to medical treatment is a right. Choosing to refuse medical treatment is a right. By going to prison, you lose both these rights. By this logic, prisoners are only entitled to compulsory medical treatment imposed upon them by the wardens, and which the prisoners themselves do not want.
April 21, 2010, 11:43 amgasman says:
But there is another party to this process. The health care provider has obligations toward the patient, and patient only, to respect autonomy, benificence/non-malfeasance, and justice. No one can provide dialysis for this patient against his express competent declaration. And anyone who does should be both civilly and criminally punished.
April 21, 2010, 1:57 pmhattio says:
Neurodoc states;
But, those aren’t the only choices. What bothers me is that we seem to see mental health as separate from other aspects of health care. If there is a right to refuse medical treatment, there should be a right to refuse medical treatment (ie., medication) for mental health. There shouldn’t be a separate rule mental health, at least absent other concerns (for example, if someone is violent when not medicated, that’s a different issue from someone just lacking touch with reality).
April 21, 2010, 5:49 pmjsr says:
So, the right of the prisoner to refuse medical treatment was upheld. If he were paroled or otherwise freed and refused to buy medical insurance because he intended to continue to refuse any medical treatment, and thus did not need the insurance, could he still be fined under new Obamacare rules? That is, could he be forced to buy insurance (or fined for not buying it) whose purpose is to cover the expense of medical treatment that he had determined not to receive?
April 22, 2010, 12:13 amneurodoc says:
What are the other choices? And what is to be done when the individual needs medical attention but lacks decision-making capacity because they are incapable of exercising rationale judgment, whether on account of an acute or chronic condition, e.g., coma, delirium, psychosis, encephalopathy, etc.? Is the presumption to be that they would all decline treatment if they could decide?
We don’t have “a separate rule (for) mental health,” we have the same rule whenever the individual is not mentally competent, e.g., it wouldn’t matter if the person were a schizophrenic hallucinating or some hallucinating on account of drugs they had taken.
April 22, 2010, 3:31 amBruce says:
There are three separate issues in the discussion above: prisoner rights; involuntary commitment to a mental health facility; and capacity (competency) to consent or refuse medical care.
Prisoners generally retain the right to refuse medical care. Exceptions are made for the safety, security, and good order of the institution (e.g. Washington v Harper allowing psychiatric involuntary medication; McCormick v Stalder allowing involuntary tuberculosis medication). Involuntary medication to render competency to stand trial is messy and I’ll avoid that topic here. There also can be exceptions for inmates who are committed to a special hospital unit for psychiatric care; again, those situations are very specialized and dependent upon the specifics of each situation.
Depending upon the jurisdiction, commitment does not mean incompetency. It may in some locations but not in North Carolina. Persons under commitment in this state do not automatically lose the ability to consent or refuse medical care. Committed but competent inpatients may receive involuntarily administered psychiatric medications on an emergency basis (e.g., for immediate dangerousness to self or others, typically an assault on the inpatient psychiatry unit) or a non-emergent basis (e.g., marked decline such as refusing to eat or drink for several days due to severe major depression). Non-emergent involuntary medication requires administrative but not judicial review. Emergency medications can only be given once; further medication requires administrative review. Your location may follow different rules and these differences may explain some of the comments above.
We also encounter patients with medical or neurologic conditions who cannot give consent. The emergency treatment rules generally guide our response; we also solicit input from family members and refer to any advance directives (living wills). We will ask a local court to appoint a guardian when the impairment is not likely to resolve quickly. All courts are different, but some will name adult protective services as a temporary guardian pending a full hearing.
Of course, none of the above applies if the patient is a minor, has been adjudicated incompetent, or has designated a health care power of attorney.
Long post, complex topic. Hope this clears up a few issues.
April 22, 2010, 11:56 pmneurodoc says:
Thanks for weighing in with an informed opinion. Sounds like you do this for a living, do you?
Any thoughts about my “hypothetical” (not entirely hypothetical) – prisoner on death row wants to die a “natural” death rather than be strapped to a gurney and be injected with drugs to end his life or be dispatched by other means (any other means currently employed in US?)? Can he prospectively refuse resuscitation in the event he experiences a cardiac arrest, that is give his own “DNR” order and have the prison staff respect it? Or can the warden tell him that should he arrest, they will attempt to resuscitate him so that he can be kept alive in order that he may be executed at the appointed time? If you do have some, I’d very much like to hear them.
April 23, 2010, 12:17 pm