Burton v. State
49 So. 3d 263, 2010 Fla. App. LEXIS 11754, 2010 WL 3168124 (2010)
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Rule of Law:
A competent pregnant woman has a fundamental constitutional right to refuse medical treatment, which the state can only overcome by demonstrating a compelling state interest in preserving the life of a viable fetus, and by showing that the chosen method for pursuing that interest is narrowly tailored and least intrusive.
Facts:
- Samantha Burton was a pregnant woman whose pregnancy was deemed "high-risk" by her attending obstetrician.
- Her obstetrician recommended a course of treatment, including hospital confinement, bed rest, administration of intravenous medications, and an anticipated surgical delivery (Cesarean section).
- Ms. Burton did not follow her doctor's instructions and recommendations, refusing the recommended medical treatment.
- A healthcare provider notified the State Attorney of Ms. Burton's refusal to submit to the recommended medical treatment.
- The State Attorney initiated legal action in the circuit court under the procedure described in In re Dubreuil to compel Ms. Burton to submit to the treatment.
Procedural Posture:
- The State Attorney initiated an action in the circuit court (trial court) to compel Samantha Burton to submit to medical treatment.
- The circuit court entered an order compelling Ms. Burton to submit to any medical treatment deemed necessary by the attending obstetrician, including detention in the hospital for enforcement of bed rest, administration of intra-venous medications, and anticipated surgical delivery of the fetus.
- Ms. Burton appealed the circuit court's order to the Florida District Court of Appeal.
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Issue:
Does a Florida trial court have the authority to compel a competent, pregnant woman to undergo medical treatment, including confinement and surgical delivery, against her will, based solely on a finding that the treatment is in the 'ultimate welfare of the child' or without first establishing a compelling state interest in a viable fetus and that the method is narrowly tailored?
Opinions:
Majority - Clark, J.
No, a Florida trial court cannot compel a competent, pregnant woman to undergo medical treatment, including confinement and surgical delivery, against her will without first establishing a compelling state interest in a viable fetus, as the trial court in this case misapplied the law and failed to make the necessary threshold determination. Florida's constitutional right to privacy (Art. I, sec. 23, Fla. Const.) grants every person, including a pregnant woman, the right to "sole control of his or her person" and to "determine what shall be done with his own body," encompassing the right to refuse medical treatment (In re Guardianship of Browning). This fundamental right can only be overridden if the state has a compelling state interest great enough to override it (Singletary v. Costello). For an unborn fetus, the state's interest becomes compelling only at the point of fetal viability, defined as when the fetus is capable of meaningful life outside the womb (Roe v. Wade, In re T.W.). The trial court failed to make a threshold determination of viability. Furthermore, the trial court misapplied the legal test from M.N. v. Southern Baptist Hosp. of Florida, which concerned an infant child and did not involve a pregnant woman's privacy rights. Even if a compelling state interest is established, the state must show that the method for pursuing that interest is "narrowly tailored in the least intrusive manner possible to safeguard the rights of the individual" (Browning).
Dissenting - Berger, W., Associate Judge
The appeal should be dismissed as moot, as the issue is not "capable of repetition yet evading review," though the trial judge did apply the wrong legal standard. This case is moot because Ms. Burton already submitted to the hospital confinement, medical treatment, and surgical delivery, rendering the controversy expired. The dissent argues that this case does not present an issue "capable of repetition yet evading review" because existing Florida and federal precedents clearly establish the law to be followed in such situations. The proper test to overcome a competent adult's right to refuse medical treatment was decided in In re Guardianship of Browning, and the procedure was outlined in In re Matter of Dubreuil. Additionally, Roe v. Wade and In re T.W. clearly state that the state's interest in an unborn child becomes compelling upon viability. While the trial judge applied the incorrect "best interest of the child" standard instead of the "compelling state interest" standard, the principles of law are not new, and therefore the appeal should be dismissed as moot.
Concurring - Van Nortwick, J.
Yes, the circuit court order should also be reversed because the proceeding below violated Samantha Burton’s constitutional right to appointed counsel, in addition to the reasons provided by the majority opinion. While the Sixth Amendment guarantees counsel in criminal proceedings, the Due Process Clause extends this right to civil proceedings when an indigent litigant faces deprivation of physical liberty (Lassiter v. Department of Social Services). Ms. Burton was involuntarily admitted to the hospital and required to undergo a Cesarean section against her will, which constitutes a significant deprivation of her physical liberty and personal freedom, equivalent to interests at stake in cases like In Re Gault, In Re Beverly (involuntary civil commitment), and In Interest of D.B. (loss of parental custody). Despite the trial court's direction for counsel to be contacted, none appeared until after the Cesarean section was performed, which does not satisfy federal and Florida due process requirements.
Analysis:
This case significantly reinforces a pregnant woman's fundamental constitutional right to bodily autonomy and medical self-determination against state intrusion. It clarifies that while the state has an interest in potential life, that interest only becomes compelling at fetal viability, and even then, must be balanced against the woman's rights using a narrowly tailored and least intrusive approach. This ruling serves to prevent judicial overreach into deeply personal medical decisions and establishes a high bar for state intervention, requiring a rigorous evidentiary showing of viability and a carefully considered plan of intervention. Future courts will be constrained from compelling medical treatment based on a generalized "best interest of the child" standard when a competent pregnant woman's privacy rights are at stake.
