Fosmire v. Nicoleau
551 N.E.2d 77, 551 N.Y.S.2d 876, 75 N.Y.2d 218 (1990)
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Rule of Law:
A competent adult has a common-law right to refuse lifesaving medical treatment. This right is not overcome by the state's general interest in preserving the patient's life or its interest in protecting a minor child from the loss of a parent, absent a specific law or regulation establishing such an interest as superior.
Facts:
- Denise Nicoleau and her husband were devout Jehovah's Witnesses whose religious beliefs prohibited them from accepting blood transfusions.
- While pregnant, Nicoleau informed her doctor and explicitly noted on her hospital admission form that she would not consent to the administration of blood or blood products.
- On December 29, 1988, Nicoleau was admitted to Brookhaven Memorial Medical Center and gave birth to a healthy baby boy via a Cesarean section.
- Following the delivery, Nicoleau began to hemorrhage, leading to a substantial and life-threatening loss of blood.
- Her attending physician informed her that she would likely die without a blood transfusion.
- Despite the doctor's warning, both Nicoleau and her husband consistently and explicitly refused to consent to a blood transfusion, citing their religious convictions.
- At the time, Nicoleau was 36 years old and, apart from the blood loss, was in good health.
Procedural Posture:
- Brookhaven Memorial Medical Center made an ex parte application to a Supreme Court Justice in Suffolk County (the trial court of first instance) for an order authorizing blood transfusions for Denise Nicoleau.
- The Supreme Court Justice signed the ex parte order, authorizing the hospital to administer the transfusions over Nicoleau's objections.
- Denise Nicoleau and her husband (appellants at this stage) applied to the Appellate Division (the intermediate appellate court) to vacate the Supreme Court's order.
- A divided panel of the Appellate Division vacated the trial court's order.
- The hospital (appellant) appealed the Appellate Division's decision to the Court of Appeals of New York (the state's highest court), and Nicoleau is the respondent.
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Issue:
Does the State's interest in preserving the life of an otherwise healthy parent and in protecting the welfare of her minor child outweigh a competent adult's common-law right to refuse a lifesaving blood transfusion on religious grounds?
Opinions:
Majority - Chief Judge Wachtler
No. A competent adult's fundamental common-law right to refuse lifesaving medical treatment is not outweighed by the State's general interests in preserving life or protecting a minor child's welfare. The court held that New York common law and statutes firmly establish the right of a competent adult to determine their own medical treatment, even if it leads to death. While this right is not absolute, the hospital failed to identify a superior State interest sufficient to override Nicoleau's choice. The court reasoned that the State's general interest in preserving life is less substantial when an individual's own actions pose a risk only to themselves, noting that declining medical care is not considered suicide. Furthermore, the court rejected the argument that Nicoleau's status as a parent created a compelling interest in protecting her child from 'abandonment,' observing that the State does not generally prohibit parents from engaging in risky activities and has not enacted any law requiring parents to undergo medical treatment for the benefit of their children.
Concurring - Judge Simons
No. Although the State's interest in preserving life and protecting a child might be sufficient to override a patient's common-law right of self-determination, it cannot overcome the patient's fundamental constitutional right to the free exercise of religion without a showing of a compelling State interest, which was absent here. This opinion disagrees with the majority's premise that a state interest must be explicitly codified in a statute to be considered. Instead, it argues for balancing traditional state interests against the patient's rights. However, the analysis is elevated to strict scrutiny because Nicoleau's refusal was based on a sincere religious belief. Under this higher standard, the State failed to demonstrate a compelling interest necessary to infringe upon her constitutional right to free exercise of religion.
Concurring - Judge Hancock, Jr.
No. The patient's right to refuse medical treatment is not absolute and must be balanced against countervailing societal interests, but the trial court erred by failing to provide notice and an opportunity to be heard before ordering the transfusion. This opinion concurs in the result but rejects the majority’s 'absolutist' rule that a state interest must be manifested in a specific statute to be cognizable. It argues that inherent societal interests in preserving life and protecting third parties always exist and must be weighed by the court in a hearing. Because the trial court granted the order ex parte without a hearing to conduct this necessary balancing of all relevant factors, its order was procedurally improper and should be vacated on that basis.
Analysis:
This decision strongly affirms the principle of patient autonomy and bodily integrity for competent adults in New York. It establishes that the status of being a parent does not, by itself, diminish this fundamental right to refuse lifesaving medical care. By requiring a legislative expression to establish a 'superior' state interest, the court set a high bar for compelling medical treatment against a patient's wishes, effectively placing the burden on the legislature to define any exceptions to this right. This precedent solidifies an individual's control over their own medical decisions, even in life-or-death situations involving dependents, prioritizing personal liberty over paternalistic state concerns.
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