New York Law Review

Tag: Right to Refuse Medical Treatment

  • Bizio v. Dorsey, 21 N.Y.3d 95 (2013): State’s Right to Force-Feed Inmate on Hunger Strike

    Bizio v. Dorsey, 21 N.Y.3d 95 (2013)

    When an inmate’s prolonged hunger strike creates a substantial risk of death or serious permanent injury, the state’s interest in preserving life and maintaining institutional order outweighs the inmate’s qualified right to refuse medical treatment.

    Summary

    Leroy Dorsey, a state inmate, engaged in a hunger strike to obtain a transfer and highlight alleged mistreatment. When his health deteriorated, the Department of Corrections and Community Supervision (DOCCS) sought a court order to force-feed him via a nasogastric tube. The New York Court of Appeals held that the state’s interest in preserving life and preventing institutional instability outweighed Dorsey’s right to refuse medical treatment, justifying the forced feeding. The Court emphasized that Dorsey’s actions created the life-threatening condition, distinguishing it from cases involving pre-existing illnesses or injuries.

    Facts

    Leroy Dorsey, an inmate, began a hunger strike at Great Meadow Correctional Facility to secure a transfer and draw attention to claims of abuse.
    Dorsey had previously engaged in hunger strikes with similar motivations.
    Medical staff repeatedly warned Dorsey that his refusal to eat was causing potentially irreversible organ damage and would lead to death.
    Dorsey only ingested small amounts of liquids, insufficient to sustain his health.
    After a month, Dorsey had lost 11.6% of his body weight.

    Procedural History

    DOCCS petitioned the court for an order permitting medical staff to insert a nasogastric tube to provide nutrition and hydration.
    Supreme Court granted DOCCS’ application, allowing force-feeding unless Dorsey consumed a nutritional supplement and solid food voluntarily.
    Dorsey resumed eating but appealed the order.
    The Appellate Division deemed the case moot because the hunger strike had ceased but addressed the core issue of the State’s right to force-feed, ruling in favor of DOCCS.
    The New York Court of Appeals granted Dorsey leave to appeal.

    Issue(s)

    1. Whether the inmate’s claim that the force-feeding order violated his constitutional right to refuse medical treatment was preserved for review.
    2. Whether the State had the right to secure a force-feeding order when an inmate, not intending to die, was engaging in a hunger strike to bring attention to grievances and obtain a transfer.

    Holding

    1. Yes, because it was clear from his posture that he viewed the insertion of a nasogastric feeding tube as an unconstitutional invasion of his bodily integrity.
    2. Yes, because when “an inmate’s refusal to eat has placed that inmate at risk of serious injury and death . . . the State’s interest in protecting the health and welfare of persons in its custody outweighs an individual inmate’s right to make personal choices about what nourishment to accept” (91 AD3d at 1053).

    Court’s Reasoning

    The Court addressed the preservation of the constitutional claim, noting DOCCS initiated the proceedings, relying on Matter of Von Holden v Chapman, which involved similar constitutional objections. The Court found that despite Dorsey’s initial reference to the Eighth Amendment, the hearing court understood the argument as based on the right to avoid unwanted medical intervention, given DOCCS’s reliance on Von Holden.
    The Court emphasized the State’s interest in preserving life, preventing suicide, and maintaining order within correctional facilities, especially when an inmate’s actions create a life-threatening condition.
    Distinguishing from Rivers v Katz and Matter of Fosmire v Nicoleau, the Court highlighted that Dorsey’s condition was self-inflicted, triggering the State’s interest in preventing suicide. The Court stated, “Whatever his purported intent, by refusing to eat for a prolonged period of time despite repeated warnings concerning the imminent physiological damage that behavior was causing, Dorsey knowingly inflicted injury on himself that, if continued, would result in his death.”
    The Court applied the Turner v Safley standard, which states that prison regulations impinging on constitutional rights are valid if reasonably related to legitimate penological interests. The Court determined that DOCCS’s actions were reasonably related to preserving life, preventing suicide, and maintaining institutional order, all legitimate penological objectives.
    The Court noted that Dorsey’s claim that he sought a transfer and brought attention to alleged mistreatment by DOCCS undermined his interest in continuing the hunger strike, as he had other available means to pursue those objectives. His stated intent did not negate the risks associated with his self-inflicted starvation.

  • Fosmire v. Nicoleau, 75 N.Y.2d 218 (1990): Patient’s Right to Refuse Blood Transfusion Despite Being a Parent

    Fosmire v. Nicoleau, 75 N.Y.2d 218 (1990)

    A competent adult has the right to refuse medical treatment, including life-saving blood transfusions, even when that person is a parent of a minor child; this right can only be overridden by a compelling state interest, and New York has no law requiring a parent to undergo medical treatment to benefit a child.

    Summary

    Denise Nicoleau, a Jehovah’s Witness, refused blood transfusions during and after childbirth due to religious beliefs. Despite this, a hospital obtained a court order to administer transfusions, citing the state’s interest in preserving her life and protecting her child. The New York Court of Appeals ultimately held that Nicoleau, as a competent adult, had the right to refuse medical treatment, even if life-saving, and that the state’s interest in preserving her life as a parent was not compelling enough to override her right to bodily autonomy and religious freedom, absent any specific law requiring her to undergo treatment.

    Facts

    Denise Nicoleau, a practical nurse and Jehovah’s Witness, informed her physician and the hospital before childbirth that she would not consent to blood transfusions due to her religious beliefs. She signed a form specifically excluding blood transfusions. After a Cesarean section, she hemorrhaged severely. Doctors informed her she would die without a transfusion, but she and her husband refused consent based on religious grounds. The hospital then sought and obtained a court order for the transfusions without prior notice to the Nicoleaus.

    Procedural History

    The Supreme Court of Suffolk County issued an ex parte order authorizing the hospital to administer blood transfusions. The Appellate Division vacated this order, holding that the Supreme Court erred by issuing the order without notice to the patient and her family. The hospital appealed to the New York Court of Appeals.

    Issue(s)

    1. Whether a competent adult has the right to refuse medical treatment, including blood transfusions, based on religious beliefs, even when that person is a parent of a minor child.
    2. Whether the State’s interest in preserving the life of a parent for the benefit of their child is a sufficiently compelling interest to override the parent’s right to refuse medical treatment.
    3. Whether the hospital was required to provide notice and a hearing to the patient before seeking a court order authorizing the transfusions.

    Holding

    1. Yes, because a competent adult has a common-law and statutory right to determine their own medical treatment, which is not absolute but can only be superseded by a compelling state interest.
    2. No, because New York has not established a legal precedent or statute that prioritizes the state’s interest in preserving a parent’s life for the sake of their child over the parent’s right to refuse medical treatment based on religious beliefs and bodily autonomy.
    3. Yes, because applications for court-ordered medical treatment affect the important rights of patients and should generally comply with due process requirements of notice and the right to be heard before the order is signed.

    Court’s Reasoning

    The Court recognized a competent adult’s right to determine their medical treatment under common law and statutes (Public Health Law §§ 2504, 2805-d), a right coextensive with the liberty interest protected by the State Constitution’s due process clause. It emphasized that this right is not absolute but can be overridden by a compelling state interest. The Court distinguished this case from situations involving children where the state has a clear interest in protecting minors. While acknowledging the state’s interest in preserving life and protecting children, the Court found no statute or legal precedent in New York requiring a parent to undergo medical treatment for the benefit of a child. The Court rejected the argument that declining essential medical care equates to parental abandonment, stating that such an interpretation would extend the concept of abandonment beyond recognized boundaries and conflict with other substantial interests. The Court also pointed out that notice and an opportunity to be heard should be provided before court-ordered medical treatment is authorized, except in cases of extreme exigency. The Court noted, “To the extent that existing statutory and decisional law manifests the State’s interest on this subject, they consistently support the right of the competent adult to make his own decisions by imposing civil liability on those who perform medical treatment without consent, although the treatment may be beneficial or even necessary to preserve the patient’s life”.