People v. BranningPeople v. Branning
delivered the opinion of the court:
In this case we pass upon the constitutionality of section 2 — 110 of the Mental Health and Developmental Disabilities Code (Code), which states as follows:
"No recipient of services shall be subjected to electro-convulsive therapy, or to any unusual, hazardous, or experimental services or psychosurgery, without his written and informed consent.
If the recipient is a minor or is under guardianship, such recipient’s parent or guardian is authorized, only with the approval of the court, to provide informed consent for participation of the ward in any such services which the guardian deems to be in the best interests of the ward.”405 ILCS 5/2 — 110 (West 1994).
We hold that the second paragraph of
On February 14, 1996, Gwendolyn Lewis, guardian of the person and estate of respondent Winifred Branning, filed a petition in the circuit court of Sangamon County requesting approval of her consent to electroconvulsive therapy (ECT) on behalf of her ward, Branning. Court-appointed counsel for the ward requested an examination by an independent psychiatrist but the request was denied. After a hearing, the circuit court entered an order on February 26, 1996, authorizing ECT. Respondent has appealed pointing out various weaknesses in the civil procedure used. We requested the parties to brief the question of the constitutionality of
The record indicates the circuit court order granting consent was stayed and on March 12, 1996, Branning was discharged from psychiatric care and never received ECT. Presumably she would no longer be subject to the order. Accordingly, the case could be dismissed as moot. However, mootness generally does not preclude review of proceedings under the Code. In re Katz,
Three factors determine whether the public interest exception applies: "(1) the public nature of the question, (2) the desirability of an authoritative determination for the purpose of guiding public officers, and (3) the likelihood that the question will generally recur.” Minor,
For the "capable of repetition, yet evading review” exception to apply, the reviewing court must find "(1) the challenged action is in its duration too short to be fully litigated prior to its cessation!,] and (2) there is a reasonable expectation that the same complaining party would be subjected to the same action again.” Minor,
Accordingly, we elect to reach the merits of the case.
A statute is facially unconstitutional only if " 'no set of circumstances exists under which the Act would be valid. The fact that the [statute] might operate unconstitutionally under some conceivable set of circumstances is insufficient to render it wholly invalid’ ” except in the context of the first amendment. In re C.E.,
"must be examined in terms of the substantive rights at stake. *** '[T]he substantive issue involves a definition of th[e] protected constitutional interest, as well as identification of the conditions under which competing state interests might outweigh it. The procedural issue concerns the minimum procedures required by the Constitution for determining that the individual’s liberty interest actually is outweighed in a particular instance.’ Mills v. Rogers,457 U.S. 291 , 299, [73 L. Ed. 2d 16 , 23,102 S. Ct. 2442 , 2448] (1982) (citations omitted).” Washington v. Harper,494 U.S. 210 , 220,108 L. Ed. 2d 178 , 197,110 S. Ct. 1028 , 1036 (1990).
In other words, in determining whether a statutory procedure affords due process, we must first determine in what, if any, factual circumstances the State may overcome the individual’s constitutionally protected interest, then determine whether the procedures which govern the presentation of this proof are adequate. See Harper,
"[ffirst, the private interest that will be affected by the official action; second, the risk of an erroneous deprivation of such interest through the procedures used, and the probable value, if any, of additional or substitute procedural safeguards; and finally, the Government’s interest, including the function involved and the fiscal and administrative burdens that the additional or substitute procedural requirement would entail.” Matthews v. Eldridge,424 U.S. 319 , 335,47 L. Ed. 2d 18 , 33,96 S. Ct. 893 , 903 (1976).
A "significant” due process liberty interest in refusing unwanted psychotropic medication clearly exists. Harper,
The two "fundamental concerns” that led the Supreme Court of Illinois to find a fundamental liberty interest in refusing psychotropic medication are present in regard to performing ECT. The first, that the treatment is of a "substantially invasive nature” and has "significant side effects” (C.E.,
The C.E. opinion held the State’s "significant parens patriae interest in providing for persons who, while suffering from a serious mental illness or developmental disability, lack the capacity to make reasoned decisions concerning their need for medication” was sufficient to overcome an individual’s interest in refusing unwanted psychotropic medication. C.E.,
As Branning has not been charged with any crime, the State has no penological interest. Cf. Harper,
Accordingly, we find the objective of providing for persons who are without the capacity to make reasoned decisions regarding their need for treatment due to a serious mental illness or developmental disability is a sufficiently compelling State interest to overcome an individual’s liberty interest in refusing unwanted treatments of the type
For the above interest to be served, the State must show the individual is unable to make a rational decision for himself regarding treatment. Since
The court must also find that the treatment is in fact in the recipient’s best interest. However, the statute may fairly be interpreted to require this as written (see below). We also find that implicit in a treatment being in a recipient’s best interest is it being the least intrusive method available.
The statute also violates procedural due process. Even a statute dealing with involuntary medication of a convicted criminal "cannot withstand challenge if there are no procedural safeguards to ensure the prisoner’s interests are taken into account.” Harper,
Austwick held two protections extended by
Austwick reached this conclusion by construing
First,
Further, the pari materia doctrine only applies when the statute being construed is ambiguous. People v. 1946 Buick, VIN 34423520,
Although not considered in Austwick, the requirement of court "approval” of the guardian’s decision is somewhat ambiguous. It may perhaps require the court to come to an independent determination that the procedure the guardian has approved would in fact be in the ward’s best interest, although we note the legislature has elsewhere expressed such conditions explicitly. See
Nor are we persuaded by the State’s argument that an individual’s liberty interest in refusing unwanted ECT is merely protected in a different way than an individual’s interest in refusing unwanted psychotropic medication. The hearing to which an individual is entitled before a guardian may be named for him under section 11a — 11 of the Probate Act of 1975 (
"[T]he patient is rarely present, is rarely represented by counsel and often no guardian ad litem is appointed. *** Thus, the guardianship system seems ill suited to the task [of making treatment decisions for hospitalized mental patients] because it may result in a substantial deprivation of the rights of the patient with few procedural protections.” Report of the Governor’s Commission to Revise the Mental Health Code of Illinois 45 (1989).
The fact that surrogate consent may only be given by a guardian does give a ward some modicum of protection as against the intentional approval of treatments not in the ward’s best interest. However, the 1976 Governor’s Commission for Revision of the Mental Health Code of Illinois stated:
"[C]ourt review of the informed consent of a mentally disabled person’s parent or guardian is *** necessary to ensure that the ward’s best interests are really the motivating concern of the decision. Unfortunately, the preference of the parent or guardian is not necessarily identical to the best interests of the ward. The potential danger, and in some instances, the irreversibility of the techniques contemplated, demand this extraordinary protection.” Report of the Governor’s Commission for Revision of the Mental Health Code of Illinois, at 32 (1976) (hereinafter 1976 Report) (comments to proposedsection 2 — 110 ).
Nor is the statute saved by the language that a facial challenge must fail unless "no set of circumstances exists under which the Act would be valid.” See Salerno,
If by its reliance on the Salerno language the State instead intends to argue that Branning has no standing to challenge the statute because she in fact received adequate process, we reject that argument as well. It is correct that Branning must show she has suffered or may reasonably expect to suffer some degree of harm from enforcement of the statute. Messenger v. Edgar,
The simple requirement of court "approval” of a guardian’s informed consent is insufficient to satisfy procedural due process. To clarify what procedures are required, we look to the Matthews (
Although we see no reason for not granting the ward protesting services under
The ward is also entitled to an independent psychiatric examination in
The second circuit has held due process does not require a consulting psychiatrist in commitment and retention proceedings in New York. Goetz v. Crosson,
We wish finally to note that we do not fault the circuit court of Sangamon County for its handling of this case. Its concern for Branning’s rights is clear from the record. Nor do we mean to suggest there was wrongdoing, improper motive or error on the part of Branning’s guardian or treating psychiatrist. Psychiatry is an inexact science, and Branning’s later release does not imply a lack of good faith in their positions at the time of the hearing. Rather, we are attempting to determine what must be done so that the result which all concerned desire, that proper treatment is provided to those unable to make reasoned decisions for themselves, may be achieved.
As we have indicated and for the reasons stated, we vacate the order of February 26, 1996, authorizing the guardian to consent to ECT upon the ward.
Vacated.
STEIGMANN, P.J., and KNECHT, J., concur.