In Re EG
133 Ill. 2d 98, 549 N.E.2d 322, 139 Ill. Dec. 810 (1989)
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Rule of Law:
A minor who is demonstrated to be mature by clear and convincing evidence has a common law right to refuse life-sustaining medical treatment. This right is not absolute and must be balanced against the state's interests in preserving life, protecting third parties, preventing suicide, and maintaining the ethical integrity of the medical profession.
Facts:
- E.G., a 17-year-old woman, was diagnosed with acute nonlymphatic leukemia.
- Her doctors stated that the necessary treatment involved blood transfusions.
- As Jehovah's Witnesses, both E.G. and her mother, Rosie Denton, refused to consent to the transfusions on religious grounds.
- Doctors testified that without the transfusions, E.G. would likely die within a month.
- The long-term survival rate for patients like E.G., even with treatment, was only 20 to 25%.
- E.G.'s doctor and a psychiatrist testified that she was competent, mature for her age, and fully understood the fatal consequences of her decision.
- The psychiatrist expressed the opinion that E.G. had the maturity level of an 18 to 21-year-old.
- E.G. testified that the decision to refuse blood was her own, based on her personal religious convictions, not a desire to die.
Procedural Posture:
- The State of Illinois filed a neglect petition against E.G.'s mother, Rosie Denton, in the juvenile division of the Cook County Circuit Court (a trial court).
- The circuit court found E.G. to be medically neglected and appointed a temporary guardian to consent to blood transfusions on her behalf.
- E.G. appealed the circuit court's decision to the Illinois Appellate Court (an intermediate appellate court).
- The appellate court reversed in part, holding that E.G. was a 'mature minor' with a First Amendment right to refuse transfusions, but it affirmed the neglect finding against her mother.
- The State of Illinois, as appellant, was granted leave to appeal to the Supreme Court of Illinois (the state's highest court), with E.G. as the appellee.
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Issue:
Does a minor who is proven to be mature by clear and convincing evidence have a common law right to refuse life-sustaining medical treatment?
Opinions:
Majority - Justice Ryan
Yes, a mature minor may possess and exercise a common law right to refuse medical treatment. The court establishes that while the age of majority is 18, it is not an 'impenetrable barrier' that prevents a minor from exercising certain adult rights. Grounding its decision in Illinois common law rather than constitutional principles, the court extends the right of dominion over one's own person to mature minors. To exercise this right in a life-or-death situation, a minor must prove their maturity by clear and convincing evidence to a trial judge. This right is not absolute and must be balanced against four State interests: (1) the preservation of life; (2) protecting the interests of third parties; (3) prevention of suicide; and (4) maintaining the ethical integrity of the medical profession. Here, the fact that E.G.'s mother supported her decision was a significant factor in the 'third parties' analysis.
Dissenting - Justice Ward
No, a minor should not have a right to refuse life-sustaining medical treatment. This holding violates the State's ancient responsibility as parens patriae to protect minors. Distinguishing this case from those involving consent to treatment, the dissent argues that a right to refuse treatment, which may lead to self-destruction, is fundamentally different. It asserts that the law clearly defines a minor as one who has not attained legal age, and creating a vague 'mature' minor exception for such a grave decision is an unprecedented and dangerous departure from the state's duty to protect children.
Dissenting - Justice Clark
The court should not have decided this case. The dissent argues that the appeal should be dismissed as moot because E.G. had already turned 18, making her a legal adult capable of making her own medical decisions. The case does not satisfy any of the exceptions to the mootness doctrine, particularly the 'public interest' exception, because the issue is so rare that it is not likely to recur. Therefore, the court's opinion is an improper advisory opinion.
Analysis:
This case established for the first time in Illinois the 'mature minor doctrine,' grounding it in state common law rather than the more controversial constitutional right to privacy. The decision shifts the legal framework from a rigid age-based standard to a fact-intensive inquiry into an individual minor's maturity and capacity. By requiring a 'clear and convincing' evidentiary standard and a balancing test against state interests, the court created a high bar for minors seeking to refuse life-sustaining care. This precedent provides a roadmap for future cases involving medical autonomy for older, demonstrably mature adolescents, influencing how courts, healthcare providers, and parents navigate these complex ethical and legal situations.
