Superintendent of Belchertown State School v. Saikewicz (1977)

See, e. g., Matter of Conroy, supra, at 351, 486 A. 2d, at 1224 (patients who refuse life-sustaining treatment “may not harbor a specific intent to die” and may instead “fervently wish to live, but to do so free of unwanted medical technology, surgery, or drugs”); Superintendent of Belchertown State School v. Saikewicz, 373 Mass. 728, 743, n. 11 , 370 N. E. 2d 417, 426, n. 11 (1977) (“[I]n refusing treatment the patient may not have the specific intent to die”).

See, e. g., Matter of Conroy, supra, at 351 , 486 A. 2d, at 1224 (patients who refuse life-sustaining treatment "may not harbor a specific intent to die" and may instead "fervently wish to live, but to do so free of unwanted medical technology, surgery, or drugs"); Superintendent of Belchertown State School v. Saikewicz, 373 Mass. 728, 743, n. 11 , 370 N. E. 2d 417, 426, n. 11 (1977) ("[I]n refusing treatment the patient may not have the specific intent to die").

See, e. g., Matter of Conroy, supra, at 351, 486 A. 2d, at 1224 (patients who refuse life-sustaining treatment “may not harbor a specific intent to die” and may instead “fervently wish to live, but to do so free of unwanted medical technology, surgery, or drugs”); Superintendent of Belchertown State School v. Saikewicz, 373 Mass. 728, 743, n. 11 , 370 N. E. 2d 417, 426, n. 11 (1977) (“[I]n refusing treatment the patient may not have the specific intent to die”).

Cf. Conroy, 98 N.J. at 321 , 486 A.2d at 1209 (court recognized constitutional right but limited its holding to application of common-law right); Matter of Conservatorship of Torres, 357 N.W.2d 332, 339-40 (Minn. 1984) (court recognized constitutional and common-law right but premised its holding on constitutional and statutory right); Storar, 52 N.Y.2d at 376 , 420 N.E.2d at 70 (whether right to refuse medical treatment is guaranteed by the Constitution is a "disputed quest…

Cf. Saikewicz, 373 Mass. at 742 , 370 N.E.2d at 426 (“The value of life as so perceived is lessened not by a decision to refuse treatment, but by the failure to allow a competent human being the right of choice”).

By embracing this position, the Court forgets our teaching in Gardner : "[T]he greater risk of abuse lies in disregarding such specifically declared personal decisions and in imposing ... [treatment] upon the patient contrary to [her] expressed will." Gardner, 534 A.2d at 947 ; cf. Saikewicz, 370 N.E.2d at 426 ("The value of life as so perceived is lessened not by a decision to refuse treatment, but by the failure to allow a competent human being the *921 right of choice.").…

The support for the equitable power discussed in Petition of the Dep ’t of Social Servs., supra, derives from Superintendent of Belchertown State Sch. v. Saikewicz, 373 Mass. 728, 755-756 (1977) (Superintendent of Belchertown). 1 There, in the course of discussing a Probate Court judge’s power to authorize a guardian ad litem to assert an incompetent individual’s right to refuse medical treatment, we noted that the judge’s power “is not limited by any narrow bounds . . .

L. c. 201D, § 2, “[e]very competent adult shall have the right to appoint a health care agent by executing a health care proxy.” This statutory right reflects the doctrine of informed consent, which promotes an individual’s “strong interest in being free from nonconsensual invasion of his bodily integrity” and protects his “human dignity and self-determination.” Superintendent of Belchertown State Sch. v. Saikewicz, 373 Mass. 728, 739 (1977).

See Superintendent of Belchertown State Sch. v. Saikewicz, 373 Mass. 728, 746 (1977) (“To protect the incompetent person within its power, the State must recognize the dignity and worth of such a person and afford to that person the same panoply of rights and choices it recognizes in competent persons”).

Superintendent of Belchertown State Sch. v. Saikewicz, 373 Mass. 728, 757 (1977) (“[s]hould the probate judge then be satisfied that the incompetent individual would, as determined by the [substituted judgment proceeding], have chosen to forgo potentially life-prolonging treatment, the judge shall issue the appropriate order”).

As Judge O’Brien noted in his previous order, many individual states have recognized a right to refuse medical treatment. 10 For example, the Massachusetts Supreme Court stated, “[t]here is implicit recognition in the law ... that a person has a strong interest in being free from nonconsensual invasion of his bodily integrity.” Superintendent of Belchertown State Sch. v. Saikewiez, 373 Mass. 728 , 370 N.E.2d 417, 424 (1977). 11 That court went on to say: Of even broader impo…

See In re Conservatorship of Torres, 357 N.W.2d 332 (Minn. 1984). 6 See also Bartling v. Superior Court, 209 Cal. Rptr. 220, 221 (Cal. Ct. App. 1984); John F. Kennedy Mem’l Hosp., Inc. v. Bludworth, 452 So. 2d 921, 923 (Fla. 1984); In re L.H.R., 321 S.E.2d 716, 718 (Ga. 1984); Superintendent of Belchertown State Sch. v. Saikewicz, 370 N.E.2d 417, 423 (Mass. 1977); In re Conroy, 486 A.2d 1209, 1219 (N.J. 1985); Eichner v. Dillon, 426 N.Y.S.2d 517 (N.Y.

See In the Matter of Moe, 385 Mass. 555, 567 (1982); Superintendent of Belchertown State School v. Saikewicz, 373 Mass. 728, 757 (1977).

Id. at 731-732, 754 .

An incompetent person, like all other individuals, is entitled to equality and respect. 20 See Superintendent of Belchertown State Sch. v. Saikewicz, 373 Mass. at 747 (“The trend in the law has been to give incompetent persons the same rights as other individuals”); Hocker, supra at 715 (“an adjudication of incompetency . . . does not make the ward any less worthy of dignity or respect in the eyes of the law than a competent person”).

See Care & Protection of Beth, 412 Mass. 188, 194-195 (1992); Superintendent of Belchertown State Sch. v. Saikewicz, 373 Mass. 728, 738-739 (1977).

E.g., Satz v. Perlmutter, 362 So.2d 160,162 (Fla.App.1978); Superintendent of Belchertown State Sch. v. Saikewicz, 373 Mass. 728 , 370 N.E.2d 417, 425 (1977); In re Conservatorship of Torres, 357 N.W.2d 332, 339 (Minn.1984); In re Conroy, 98 N.J. 321 , 486 A.2d 1209, 1223 (1985); In re Colyer, 99 Wash.2d 114 , 660 P.2d 738, 743 (1983) (en banc); President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Deciding to Forego Lif…

In Massachusetts jurisprudence, protected decisions generally have been limited to those concerning “whether or not to beget or bear a child,” Matter of Moe, 385 Mass. 555, 564 (1982) (see Opinion of the Justices, 423 Mass. 1201, 1234-1235 [1996] [“focus of (the Griswold and Roe cases) and the cases following them has been the intrusion . . . into the especially intimate aspects of a person’s life implicated in procreation and childbearing”]); how to raise a child, see Care …

It stands to reason that the least restrictive alternative is a Probate Court guardianship, rather than the District Court process. “’ [I]f the doctrines of informed consent and right of privacy [that underlie the substituted judgment determination] have as their foundations the right to bodily integrity and control of one’s own fate, then those rights are superior to the institutional considerations.’” (citations omitted) Rogers v. Commissioner of Department of Mental Healt…

See Brophy v. New England Sinai Hosp., Inc., 398 Mass. 417, 430 (1986); Superintendent of Belchertown State Sch. v. Saikewicz, 373 Mass. 728, 739, 742 (1977) (right to refuse medical treatment is rooted in common-law jurisprudence and guaranteed through constitutional right to privacy); Matter of Spring, 380 Mass. 629, 634 (1980).

Superintendent of Belchertown v. Saikewicz, 373 Mass. 728, 741-42 , 370 N.E.2d 417, 425-26 (1977) (patient's leukemia was incurable, treatment had painful side effects, and the disease would soon cause death regardless of any medical treatment).

Medical Ctr., 387 Mass. 152, 154 (1982), citing Superintendent of Belchertown State Sch. v. Saikewicz, 373 Mass. 728, 738-739 (1977); Matter of Spring, 380 Mass. 629, 634, 637-638 (1980).

“By allowing guardians to make such decisions regarding dissolution actions, a court preserves ‘the dignity and worth of such a person [an incompetent] and affords to that person the same panoply of rights and choices it recognizes in competent persons.’ ” Drews, 115 Ill. 2d at 208 (Simon, J., dissenting), quoting Superintendent of Belchertown State School v. Saikewicz, 373 Mass. 728, 746 , 370 N.E.2d 417, 428 (1977).

The right of privacy encompasses the right to refuse medical treatment because "a person has a strong interest in being free from nonconsensual invasion of his [or her] bodily integrity." Superintendent of Belchertown State School v. Saikewicz, 373 Mass. 728 , 370 N.E.2d 417, 424 (1977).

Superintendent of Belchertown State School v. Saikewicz, 373 Mass. 728, 739-740 (1977).

However, we note that "in Massachusetts there is 'a general right in all persons to refuse medical treatment in appropriate circumstances,' and that right extends to 'an incompetent, as well as a competent, patient.'" Zaleskas v. Brigham & Women's Hosp., 97 Mass. App. Ct. 55 , 62 (2020), quoting Superintendent of Belchertown State Sch. v. Saikewicz, 373 Mass. 728, 745-746 (1977).

Footnote 8: Under the substituted judgment standard, the Surrogate's task is to reconstruct what the patient himself would want if he had decision-making capacity (see Superintendent of Belchertown State Sch. v. Saikewicz , 370 NE2d 417, 430-31 (Mass. 1977).

Footnote 8: Under the substituted judgment standard, the Surrogate's task is to reconstruct what the patient himself would want if he had decision-making capacity (see Superintendent of Belchertown State Sch. v. Saikewicz , 370 NE2d 417, 430-31 (Mass. 1977).

R., 442 U.S. 584, 626 , 99 S. Ct. 2493, 2516 (1979) (Brennan, J., dissenting on other grounds); Rennie v. Klein, 462 F. Supp. 1131, 1144-45 (D.N.J. 1978) (on motion for preliminary injunction); Superintendent of Belchertown State Sch. v. Saikewicz, 370 N.E.2d 417, 424 (Mass. 1977); In re Mental Health of K.K.B., 609 P.2d 747, 750 (Okla. 1980); cf. Ingraham v. Wright, 430 U.S. 651, 673 , 97 S. Ct. 1401, 1413 (1977) (“Among the historic liberties [protected by the Due Process …

See Parham v. J.R., 442 U.S. 584, 626 , 99 S. Ct. 2493, 2516 (1979) (Brennan, J., dissenting on other grounds); Rennie v. Mein, 462 F. Supp. 1131, 1144-45 (D.N.J. 1978) (on motion for preliminary iqjunction); Superintendent of Belchertown State Sch. v. Saikewicz, 370 N.E.2d 417, 424 (Mass. 1977); In re Mental Health of K.K.B., 609 P.2d 747, 750 (Okla. 1980); cf. Ingraham v. Wright, 430 U.S. 651, 673 , 97 S. Ct. 1401, 1413 (1977) (“Among the historic liberties [protected by t…

This notice must be unambiguous, given that it activates the health care agent’s power to make binding medical decisions on the principal’s behalf, thereby implicating the principal’s “strong interest in being free from nonconsensual invasion of his bodily integrity.” Johnson v. Kindred Healthcare, Inc., supra at 782, quoting Superintendent of Belchertown State Sch. v. Saikewicz, 373 Mass. 728, 739 (1977).

“As distilled from the cases, the State has claimed interest in: (1) the preservation of life; (2) the protection of the interests of innocent third parties; (3) the prevention of suicide; and (4) maintaining the ethical integrity of the medical profession.” Superintendent of Belchertown State Sch. v. Saikewicz, 373 Mass. 728, 741 (1977).

See Matter of Moe , 385 Mass, at 565; Superintendent of Belchertown State Sch. v. Saikewicz, 373 Mass. 728, 751-752 (1977); G.

Guardianship of Roe, [supra at 433], This right extends to incompetent as well as competent persons ‘because the value of human dignity extends to both.’ Rogers v. Commissioner of the Dep’t of Mental Health, 390 Mass. 489, 499-500 (1983), quoting Superintendent of Belchertown State School v. Saikewicz, 373 Mass. 728, 745-746 (1977).

(Superintendent of Belchertown State School v Saikewicz, 373 Mass 728, 746, 370 NE2d 417, 428 [1977].) .

Id. (citing Superintendent of Belchertown v. Saikewicz, 373 Mass. 728 , 370 N.E.2d 417, 425-26 (1977)). ¶ 38 In this case, D.L.H. was a life-long incompetent who developed aspiration pneumonia.

See, e.g., Rasmussen v. Fleming, 154 Ariz. 207 , 741 P.2d 674, 682 (1987) (federal and state); Bouvia v. Superior Court, 179 Cal.App.3d 1127 , 225 Cal.Rptr. 297, 301 (1986) (federal and state); In re Severns, 425 A.2d 156, 158 (Del.Ch.1980) (federal); In re A.C., 573 A.2d 1235, 1244-47 (D.C.1990) (federal); In re Guardianship of Browning, 543 So.2d 258, 267 (Fla.Dist.Ct.App.1989) (state), aff'd, 568 So.2d 4 (Fla.1990); Brophy, 497 N.E.2d at 633 (federal); Superintendent of B…

Ctr., 387 Mass. 152, 154 (1982); Superintendant of Belchertown State Sch. v. Saikewicz, 373 Mass. 728, 744-745 (1977).

This case is unlike Superintendent of Belchertown State Sch. v. Saikewicz, 373 Mass. 728, 729-732, 746-747, 752-754 (1977), where the judge appointed a guardian ad litem to aid him in applying a “substituted judgment” whether a permanently and profoundly incompetent person in the Commonwealth’s care, diagnosed with an incurable and life-threatening disease, should be subjected to dangerous and unpleasant life-prolonging treatment.

Superintendent of Belchertown State School v. Saikewicz, 373 Mass. 728, 740-41 (1977) (“Saikewicz”).

Matter of R.H., 35 Mass.App.Ct. 478 , 622 N.E.2d 1071, 1077 (1993) (citations omitted); see also Oller v. Oller-Chiang, 230 Conn. 828 , 646 A.2d 822, 834-35 (1994) (when considering guardianship appointment for mentally retarded individual, court must take reasonable efforts “to ascertain the [individual’s] preference”); Stiperintendent of Belchertoim State School v. Saikewicz, 373 Mass. 728 , 370 N.E.2d 417, 430 (1977) (in making medical decisions on behalf of a mentally in…

See E.N.O. v. L.M.M., supra at 827-828 ; Superintendent of Belchertown State Sch. v. Saikewicz, 373 Mass. 728, 755-756 (1977).

Apart from its statutory authority, “the Probate Court may appoint a guardian ad litem whenever the court believes it necessary to protect the interests of a person in a proceeding before it.” Superintendent of Belchertown State Sch. v. Saikewicz, 373 Mass. 728, 755 (1977), citing Buckingham v. Alden, 315 Mass. 383, 387 (1944).

“It is not necessary to deny a right of self-determination to a patient in order to recognize the interests of doctors, hospitals, and medical personnel in attendance on the patient.” Superintendent of Belchertown State School v. Saikewicz, 873 Mass. 728 , 370 N.E.2d 417, 426-427 (1977).

See In re A.C., 573 A.2d 1285, 1249 (D.C.1990) (en banc); Superintendent of Belchertown State School v. Saikewicz, 873 Mass. 728 , 370 N.E.2d 417, 431 (1977).

See In re A.C., 573 A.2d 1235, 1249 (D.C.1990) (en banc); Superintendent of Belchertown State School v. Saikewicz, 373 Mass. 728 , 370 N.E.2d 417, 431 (1977).

Although not controlling in this case, the court notes that in Superintendent of Belchertown State School v Saikewicz (373 Mass 728, 745, 370 NE2d 417, 427 [1977]), the Supreme Judicial Court of Massachusetts recognized that the right to refuse medical treatment “must extend to the case of an incompetent, as well as a competent, patient because the value of human dignity extends to both.” Consequently, in Massachusetts, when an incompetent person refuses antipsychotic drugs,…

App. 3d at 404 , 632 N.E.2d at 334 ; Superintendent of Belchertown State School v. Saikewicz, 373 Mass. 728, 741 , 370 N.E.2d 417, 425 (1977).

App. 3d at 404 , 632 N.E.2d at 334 ; Superintendent of Belchertown State School v. Saikewicz , 373 Mass. 728, 741 , 370 N.E.2d 417, 425 (1977).

One means by which the law has developed in a manner consistent with the protection of this interest is through the development of the doctrine of informed consent.’ Superintendent of Belchertown State Sch. v. Saikewicz, 373 Mass. 728, 738-739 (1977).” Harnish, supra at 154 .