In re E.G., a Minor (The People of the State of Illinois, Appellant,
v.
E.G., a Minor, Appellee).
Supreme Court of Illinois.
*99 *100 Neil F. Hartigan, Attorney General, of Springfield, and Richard M. Daley and Cecil A. Partee, State's Attorneys, of Chicago (Terence M. Madsen, Assistant Attorney General, of Chicago, and Thomas V. Gainer, Jr., *101 Kenneth T. McCurry, Kim A. Novi, Inge Fryklund, Renee Goldfarb and James E. Fitzgerald, Assistant State's Attorneys, of counsel), for the People.
Jane M. Whicher, Harvey Grossman and Diane Geraghty, of Chicago, for appellee.
Donald T. Ridley, of Brooklyn, New York, for amicus curiae Watchtower Bible and Tract Society of New York, Inc.
Appellate court affirmed in part and reversed in part; circuit court reversed; case remanded.
JUSTICE RYAN delivered the opinion of the court:
Appelleе, E.G., a 17-year-old woman, contracted leukemia and needed blood transfusions in the treatment of the disease. E.G. and her mother, Rosie Denton, refused to consent to the transfusions, contending that acceptance of blood would violate personal religious convictions rooted in their membership in the Jehovah's Witness faith. Appellant, the State of Illinois, filed a neglect petition in juvenile court in the circuit court of Cook County. The trial court entered an order finding E.G. to be neglected, and appointed a guardian to consent to the transfusions on E.G.'s behalf.
The appellate court reversed the trial court in part. The court held that E.G. was a "mature minor," and therefore could refuse the blood transfusions through the exercise of her first amendment right to freely exercise her religion. Nevertheless, the court affirmed the finding of neglect against Denton.
We granted the State's petition for leave to appeal and now affirm the appellate court's decision in part, but on other grounds. We also remand this case to the trial court for the purpose of expunging the finding of neglect.
In February of 1987, E.G. was diagnosed as hаving acute nonlymphatic leukemia, a malignant disease of the white blood cells. When E.G. and her mother, Rosie Denton, *102 were informed that treatment of the disease would involve blood transfusions, they refused to consent to this medical procedure on the basis of their religious beliefs. As Jehovah's Witnesses, both E.G. and her mother desired to observe their religion's prohibition against the "eating" of blood. Mrs. Denton did authorize any other treatment and signed a waiver absolving the medical providers of liability for failure to administer transfusions.
As a result of Denton's and E.G.'s refusal to assent to blood trаnsfusions, the State filed a neglect petition in juvenile court. At the initial hearing on February 25, 1987, Dr. Stanley Yachnin testified that E.G. had approximately one-fifth to one-sixth the normal oxygen-carrying capacity of her blood and consequently was excessively fatigued and incoherent. He stated that without blood transfusions, E.G. would likely die within a month. Dr. Yachnin testified that the transfusions, along with chemotherapy, achieve remission of the disease in about 80% of all patients so afflicted. Continued treatment, according to Dr. Yachnin, would involve the utilization of drugs and more transfusions. The long-term prognоsis is not optimistic, as the survival rate for patients such as E.G. is 20 to 25%.
Dr. Yachnin stated that he discussed the proposed course of treatment with E.G. He testified that E.G. was competent to understand the consequences of accepting or rejecting treatment, and he was impressed with her maturity and the sincerity of her beliefs. Dr. Yachnin's observations regarding E.G.'s competency were corroborated by the testimony of Jane McAtee, the associate general counsel for the University of Chicago Hospital. At the conclusion of this hearing, the trial judge entered an order appointing McAtee temporary guardian, and authorizing her to consent to transfusions on E.G.'s behalf.
*103 On April 8, 1987, further hearings were held on this matter. E.G., having received several blood transfusions, was strong enough to take the stand. She testified that the decision to refuse blood transfusions was her own and that she fully understood the nature of her disease and the consequences of her decision. She indicated that her decision was not based on any wish to die, but instead was grounded in her religious convictions. E.G. further stated that when informed that she would undergo transfusions, she asked to be sedated prior to the administration of the blood. She testified that the court's decision upset her, and said: "[I]t seems as if everything that I wanted or believe in was just being disregarded."
Several other witnesses gave their opinions extolling E.G.'s maturity and the sincerity of her religious beliefs. One witness was Dr. Littner, a psychiatrist who has special expertise in evaluating the maturity and competency of minors. Based on interviews with E.G. and her family, Dr. Littner expressed his opinion that E.G. had the maturity level of an 18 to 21 year old. He further concluded that E.G. had the competency to make an informed decision to refuse the blood transfusiоns, even if this choice was fatal.
On May 18, 1987, the trial court ruled that E.G. was medically neglected, and appointed a guardian to consent to medical treatment. The court felt this was in E.G.'s best interests. The court did state, however, that E.G. was "a mature 17-year-old individual," that E.G. reached her decision on an independent basis, and that she was "fully aware that death [was] assured absent treatment." The court noted that it considered E.G.'s maturity and the religion of her and her parents, and that it gave great weight to the wishes of E.G. Nevertheless, the court felt that the State's interest in this case was greatеr than the interest E.G. and her mother *104 had in refusing to consent to treatment. The court concluded its ruling by encouraging E.G. to appeal.
On appeal, the order of the trial court pertaining to E.G.'s right to refuse treatment was vacated in part and modified in part. (
The appellate court noted that E.G., at the time of trial, was only six months shy of her eighteenth birthday, and that the trial court believed E.G. to be a mature individual. Based on these facts, the appellate court declared that E.G. was partially emancipated and therefore had the right to refuse transfusions. The court, however, affirmed the finding of neglect against Denton, E.G.'s mother.
We granted the State's petition for leave to appeal under our Rule 315 (107 Ill.2d R. 315). This case presents several issues for our consideration: (1) whether this appeal should be dismissed as moot, since E.G. *105 turned 18 on November 25, 1987, and is no longer a minor; (2) whether a minor has a right to refuse medical treatment and if so, how this right may be exercised; and (3) whether the trial court's finding of neglect against Denton should stand.
Bоth parties agree that although this case is technically moot, it should not be dismissed. Normally, this court will not adjudicate an appeal where a live controversy no longer exists. (People ex rel. Black v. Dukes (1983),
Nevertheless, there are exceptions to the mootness doctrine. One departure from the usual rule occurs when a case presents an issue of substantial public interest. (In re Estate of Brooks (1965),
The paramount issue raised by this appeal is whether a minor like E.G. has a right to refuse medical treatment. In Illinois, an adult has a common law right to refuse medical treatment, even if it is of a life-sustaining nature. (See In re Estate of Longeway (1989),
In Illinois, our legislature enacted "An Act in relation to the performance of medical, dental or surgical procedures on and counseling for minors" (the Consent by Minors to Medical Operations Act), which grants minors the legal capacity to consent to medical treatment in certain situations. (See Ill. Rev. Stat. 1987, ch. 111, par. 4501 et seq.) For example, a minor 12 years or older may seek medical attention on her own if she believes she has venereal disease or is an alcoholic or drug addict. (Ill. Rev. Stat. 1987, ch. 111, par. 4504.) Similarly, an individual under 18 who is married or pregnant may validly consent tо treatment. (Ill. Rev. Stat. 1987, ch. 111, par. *107 4501.) Thus, if E.G. would have been married she could have consented to or, presumably, refused treatment. Also, a minor 16 or older may be declared emancipated under the Emancipation of Mature Minors Act (Ill. Rev. Stat. 1987, ch. 40, par. 2201 et seq.), and thereby control his or her own health care decisions. These two acts, when read together in a complementary fashion, indicate that the legislature did not intend that there be an absolute 18-year-old age barrier prohibiting minors from consenting to medical treatment.
In an analogous area of law, no "bright line" age restriction of 18 exists either. Under the Juvenile Court Act, individuals much younger than 18 may be prosecuted under the Criminal Code, if circumstances dictate. (See Ill. Rev. Stat. 1987, ch. 37, par. 805-4.) Furthermore, to be convicted of many of the offenses in the Criminal Code, a trier of fact would have to find that a minor had a certain mental state at the time the alleged crime was committed. Implied in finding this mental state would be an acknowledgment that a minor was mature enough to have formulated this mens rea. Consequently, the Juvenile Court Act presupposes a "sliding scale of maturity" in which young minors can be deеmed mature enough to possess certain mental states and be tried and convicted as adults. This act reflects the common law, which allowed infancy to be a defense to criminal acts. The infancy defense at common law was "based upon an unwillingness to punish those thought to be incapable of forming criminal intent and not of an age where the threat of punishment could serve as a deterrent." (Emphasis added.) (W. LaFave & A. Scott, Criminal Law § 46 (1972).) When a minor is mature enough to have the capacity to formulate criminal intent, both the common law and our Juvenile Court Act treat the minor as an adult.
*108 Another аrea of the law where minors are treated as adults is constitutional law, including the constitutional right of abortion. The United States Supreme Court has adopted a mature minor doctrine, which allows women under the age of majority to undergo abortions without parental consent. (See City of Akron v. Akron Center for Reproductive Health, Inc. (1983),
The common law right to control one's health care was also the basis for the right of an incompetent patient to refuse life-sustaining treatment through a surrogate in In re Estate of Longeway,
In Cardwell, the Tennessee court held that a minor 17 years, 7 months old was mature enough to consent to medical treatment. We note that in other jurisdictions, courts have ordered health care for minors over the objections of the minors' parents. These cases, however, involve minors who were younger than E.G. or the minor in Cardwell. (See, e.g., In re Eric B. (1987),
The trial judge must determine whether a minor is mature enough to make health care choices on her own. An exception to this, of course, is if the legislature has provided otherwise, as in the Consent by Minors to Medical Operations Act (Ill. Rev. Stat. 1987, ch. 111, par. 4501 et seq.). We feel the intervention of a judge is appropriate for two reasons.
First, Illinois public policy values the sanctity of life. (In re Estate of Longeway,
Second, the State has a parens patriae power to protect those incompetent to protect themselves. (Longeway,
Therefore, the trial judge must weigh these two principles against the evidence he receives of a minor's maturity. If the evidence is clear and convincing that the minor is mature enough to appreciate the consequences of her actions, and that the minor is mature enough to exercise the judgment of an adult, then the mature minor doctrine affords her the common law right to consent to or refuse medical treatment. As we stated in Longeway, however, this common law right is not absolute. The right must be balanced against four State interests: (1) the preservation of life; (2) protecting the interests of third parties; (3) prevention of suicide; and (4) maintaining the ethical integrity of the medical profession. (Longeway,
Nevertheless, in this case bоth E.G. and her mother agreed that E.G. should turn down the blood transfusions. They based this refusal primarily on religious grounds, contending that the first amendment free exercise clause entitles a mature minor to decline medical care when it contravenes sincerely held religious beliefs. Because we find that a mature minor may exercise a common law right to consent to or refuse medical care, we decline to address the constitutional issue. See Longeway,
The final issue we must address is whethеr the finding of neglect entered against Rosie Denton, E.G.'s mother, should stand. If the trial judge had ruled that E.G. was a mature minor, then no finding of neglect would be proper. Although the trial judge was impressed with E.G.'s maturity and sincerity, the judge did not explicitly hold that E.G. was a mature minor. The trial judge, guided only by the law as it existed prior to this opinion, rightly felt that he must protect the minor's health and well-being. This case is one of first impression with this court. Therefore, the trial judge had no precedent upon which to base a mature minor finding. Because E.G. is no longer a minor, nothing would be gained by remanding this case back to the trial court for an explicit determination of E.G.'s maturity. Nevertheless, since the trial judge did not have any clear guidance *113 on the mature minor doctrine, we believe that the finding of neglect should not stand. Accordingly, we affirm the appellate court in part and reverse in part, and remand this case to the circuit court of Cook County for the sole purpose of expunging the finding of neglect against Denton.
Appellate court affirmed in part and reversed in part; circuit court reversed; case remanded with directions.
JUSTICE WARD, dissenting:
I must respectfully dissent. I consider the majority has made an unfortunate choice of situations to announce, in what it calls a case of first impression, that a minor may with judicial approval reject medical treatment, even if the minor's death will be a medically certain consequence. The majority cites decisions where a minor was permitted to exercise what was called a common law right to consent to medical treatment. The safeguarding of health and the preservation of life are obviously different conditions from one in which a minor will be held to have a common law right, as the majority puts it, to refusе medical treatment and sometimes in effect take his own life. That violates the ancient responsibility of the State as parens patriae to protect minors and to decide for them, as the majority describes, vital questions, including whether to consent to or refuse necessary medical treatment. The majority also cites the decision in In re Estate of Longeway (1989),
Unless the legislature for specific purposes provides for a different age, a minor is one who has not attained legal age. It is not disputed that E.G. has not attained legal age. It is a fundamental that where language is clear there is no need to seek to interpret or depаrt from the plain language and meaning and read into what is clear exceptions or limitations. The majority nevertheless would in effect define a minor in these grave situations to be one who has not attained legal age unless it is a "mature" minor who is involved. If so this protection that the law gives minors has been lost and the child may make his own decision even at the cost of his life. The majority acknowledges that this is a case of first impression. It may now be critically described by some as a holding without precedent. I point out again that this is not a holding where consent to treatmеnt is the question but rather a unique one where a minor's injury or very self-destruction may be involved.
I am sure that in a host of matters of far lesser importance it would not be held that a minor however mature could satisfy a requirement of being of legal age. It would not be held that a minor was eligible to vote, to obtain a driver's or a pilot's license, or to enlist in one of the armed services before attaining enlistment age.
The trial court appointed a guardian to consent to transfusions for the minor. The appellate court reversed as to this, stating the minor was a mature minor. This court affirms the appellate court in this regard but does not attempt to state a standard by which "mature" is to be measured by judges in making these important findings.
*115 JUSTICE CLARK, also dissenting:
I respectfully dissent from the majority's opinion because I do not believe that this case falls within any exception to the mootness doctrine. Accordingly, I would dismiss the case.
As the majority recognizes, and both parties agree, this case is moot. (
The majority concludes that the public interest exception applies in this case. (
The majority states that "[t]he paramount issue raised by this appeal is whether [an allegedly mature] minor like E.G. has a right to refuse medical treatment." (
The two cases cited by the majority in support of its decision to address the merits of this appeal, In re Estate of Brooks (1965),
Brooks and Labrenz are distinguishable because the circumstances which gave rise to the actions in those *117 cases were likely to recur. In Brooks, it was likely that, in the future, the incompetent adult would be in need of further blood transfusions. Similarly, it was quite possible that the eight-day-old infant in Labrenz would be in need of a blood transfusion at some time in the future while she was still a minor and that her parents would object to any such transfusion. In both instances, the identical issues that were raised in Brooks and Labrenz would be raised again as to the same parties. In the instant case, however, E.G. has already turned 18 and therefore is no longer a minor. As a result, even if E.G. needs a blood transfusion in the future, the question of whether a mature minor has the right to refuse medical treatment will not be raised. I therefore do not believe that the public interest exception should be applied in this case.
A second exception which E.G. claims is applicable arises when a party to a proceeding will continue to suffer collateral consequences, such as limitations on the party's personal life or employment opportunities, if an allegedly erroneous ruling is allowed to stand. The problem with E.G.'s argument, however, is that while it may be true that there is a collateral-consequences exception to the mootness doctrine, such a doctrine clearly does not apply here. The doctrine does not apply here because, according to E.G., the only party who will suffer collateral consequences, if the trial court's ruling is allowed to stand, is E.G.'s mother. Although E.G.'s mother was a party to the proceedings in the trial court, she is not a party to this appeal. The cases cited by E.G. in support of her argument, however, all involve situations wherein a party to the appeal would suffer collateral consequences if the appeal were dismissed as moot. (See In re Christenberry (1979),
The final exception to the mootness doctrine which E.G. claims applies in this case is the exception permitting review of moot cases when the cases involve events of short duration which are capable of repetition yet, due to the events' short durations, will continually evade review. For this exception to apply, however, the party claiming the exception must show "a reasonable expectation that the same complaining party would be subjected to the same action again." (In re a Minor (1989),
Because I do not believe that any of the exceptions to the mootness doctrine are applicable here, I would dismiss this appeal as moot without addressing the merits of the parties' claims. I therefore respectfully dissent.