Guardianship of Moe.
2012 WL 104915, 81 Mass. App. Ct. 136, 960 N.E.2d 350 (2012)
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Rule of Law:
When deciding whether to authorize extraordinary medical procedures such as abortion or sterilization for an incompetent person, a court must apply the substituted judgment doctrine, which requires determining what the person would choose if competent, not what is in their best interest. Such a determination requires strict adherence to procedural due process, including notice and an evidentiary hearing.
Facts:
- Mary Moe, a thirty-two-year-old woman, suffers from schizophrenia or schizo-affective disorder and bipolar mood disorder.
- Moe became pregnant for a third time; she previously had one abortion and later gave birth to a son who is in her parents' custody.
- Moe stated that she is 'very Catholic,' does not believe in abortion, and would never have one.
- Due to her mental illness, Moe suffered from delusions, including denying her current pregnancy and believing she had previously given birth to a baby girl.
- Moe's parents believed it was in their daughter's best interest to terminate the pregnancy.
- A court-appointed guardian ad litem (GAL) investigated the matter and concluded that if Moe were competent, she would decide against having an abortion.
- Moe becomes agitated and emotional when discussing her prior abortion, during which time she believed people were stating that she killed her baby.
Procedural Posture:
- The Department of Mental Health filed a petition in the Probate and Family Court to appoint Mary Moe’s parents as temporary guardians to consent to an abortion.
- The probate judge conducted an initial hearing and found Moe incompetent to make a decision about the abortion.
- The judge appointed a guardian ad litem (GAL) to investigate and submit a report on the issue of substituted judgment.
- The GAL submitted a report concluding that, under a substituted judgment analysis, Moe would choose not to have an abortion if she were competent.
- Without conducting a further evidentiary hearing, the probate judge issued a final order appointing the parents as guardians to consent to an abortion and, sua sponte, ordered that Moe also be sterilized.
- Mary Moe appealed the final order to the Massachusetts Appeals Court.
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Issue:
Does a court order compelling an abortion and sterilization for a mentally incompetent person violate the substituted judgment doctrine and the person's due process rights when the order is based on the judge's own reasoning contrary to the person's expressed wishes, ignores a guardian ad litem's recommendation, and is issued without a full evidentiary hearing or proper notice?
Opinions:
Majority - Grainger, J.
Yes. A court order compelling abortion and sterilization under these circumstances violates the substituted judgment doctrine and the person's due process rights. The right to make decisions about bearing a child is fundamental and extends to incompetent persons. For sterilization, the probate judge's sua sponte order without notice or a hearing was a clear violation of constitutionally required due process. For abortion, the judge failed to apply the substituted judgment doctrine correctly. Instead of determining what Moe would choose if competent, the judge improperly substituted his own logic, reasoning that a competent person 'would not choose to be delusional' and would therefore opt for an abortion to receive certain medications. This approach misapplies the doctrine, which requires the court to respect the decision the individual would make—even if seemingly unwise—based on their own values, beliefs, and expressed preferences. The judge's failure to conduct a required evidentiary hearing further violated statutory procedure and Moe's due process rights.
Analysis:
This decision strongly reinforces the distinction between the 'best interest' standard and the 'substituted judgment' doctrine in cases involving the fundamental rights of incompetent individuals. The court clarifies that a judge's personal view of a wise or logical outcome cannot replace a rigorous, evidence-based inquiry into what the specific individual would have wanted. By vacating the lower court's order, the appellate court sets a strong precedent against judicial overreach and underscores the critical importance of procedural safeguards, such as notice and evidentiary hearings, before the state can authorize invasive and irrevocable medical procedures. This case serves as a crucial guidepost for lower courts, demanding a more person-centered analysis that honors the incompetent individual's known values and preferences.
