Aden v. Younger
1976 Cal. App. LEXIS 1482, 129 Cal. Rptr. 535, 57 Cal.App.3d 662 (1976)
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Rule of Law:
A state's regulation of intrusive or hazardous medical procedures for mental patients, while serving a compelling interest, is unconstitutional if it is impermissibly vague, infringes on the patient's right to privacy without justification, or subjects the informed decision of a competent, voluntary patient to substantive review for a non-experimental treatment.
Facts:
- Petitioner Jane Doe, a mentally ill individual, has previously undergone electroconvulsive therapy (ECT) and may require further voluntary treatments.
- Petitioner Betty Roe, another mentally ill individual, sought to undergo a surgical procedure known as psychosurgery.
- Petitioners Dr. Aden and Dr. Brown are the licensed, board-certified physicians treating Doe and Roe, respectively.
- California enacted amendments to the Lanterman-Petris-Short Act, imposing new procedural requirements for administering psychosurgery and ECT to both voluntary and involuntary mental patients.
- The new law required physicians to obtain written informed consent, which included an oral explanation to the patient and a 'responsible relative' of all possible risks and side effects.
- The law also mandated that before either procedure could be performed, a review committee of three physicians had to unanimously agree with the treating physician's determinations.
- This committee approval was conditioned on findings that, among other things, the patient had the capacity to consent and that the treatment was 'critically needed for the welfare of the patient.'
Procedural Posture:
- Petitioners Jane Doe, Betty Roe, and their physicians filed a petition for a writ of mandate directly in the California Court of Appeal, Fourth District.
- The petitioners named the California Attorney General, the Director of Health, and the Board of Medical Examiners as respondents.
- The petition sought to permanently prevent the respondents from enforcing recently enacted amendments to the Lanterman-Petris-Short Act concerning psychosurgery and shock treatment.
- The Court of Appeal exercised its original jurisdiction to hear the case directly, bypassing the trial court, due to the great public importance of the issues and the need for a prompt resolution.
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Issue:
Do California's statutory requirements for informed consent and substantive review for psychosurgery and electroconvulsive therapy (ECT), including the 'critically needed' standard and mandatory disclosure to a 'responsible relative,' unconstitutionally violate a mental patient's rights to privacy and due process?
Opinions:
Majority - Brown (Gerald), P. J.
Yes, several key provisions of the statutory requirements are unconstitutional. While the state has a compelling interest in protecting mental patients and regulating hazardous medical procedures, these regulations must be narrowly tailored and cannot infringe upon fundamental constitutional rights. The court found that the requirement to inform a 'responsible relative' is an unconstitutional violation of the patient's right to privacy and confidentiality, as it serves no compelling state interest. The statutory standard that a procedure must be 'critically needed' is impermissibly vague because it fails to provide a discernible standard for physicians and review committees to apply. For psychosurgery, which is experimental and hazardous, the review process for all patients is justified by the state's interest in regulating such procedures. However, for electroconvulsive therapy (ECT), which is a non-experimental treatment, subjecting the decision of a competent and voluntary patient to substantive review by a committee unconstitutionally infringes upon that patient's fundamental right to privacy and to make their own medical decisions, akin to the principles established in Roe v. Wade and Doe v. Bolton.
Analysis:
This decision carefully balances the state's paternalistic power to protect vulnerable individuals against a patient's fundamental rights to privacy and autonomy in medical decision-making. The court establishes a critical distinction based on the nature of the treatment, allowing greater state intervention for experimental procedures like psychosurgery while protecting a competent patient's choice for established, non-experimental treatments like ECT. By striking down the 'critically needed' standard for vagueness and the 'responsible relative' disclosure for violating privacy, the case reinforces that state regulations in this sensitive area must be precise, justified by a compelling interest, and utilize the least restrictive means possible.
