Matter of Dubreuil
629 So.2d 819, 18 Fla. L. Weekly Supp. 575, 1993 Fla. LEXIS 1761 (1993)
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Rule of Law:
A competent adult's constitutional right to refuse medical treatment cannot be overridden by the state's interest in preventing the abandonment of minor children unless the state proves by clear and convincing evidence that the children would, in fact, be abandoned. The legal presumption that a surviving parent will assume custody must be rebutted, and the burden of proof rests with the State, not the healthcare provider.
Facts:
- Patricia Dubreuil, a Jehovah's Witness, was admitted to Memorial Hospital for the delivery of her fourth child.
- At the time, she was married to but separated from Luc Dubreuil, and their four minor children lived with her.
- Following a Caesarean section, Patricia suffered severe blood loss, and physicians determined a blood transfusion was necessary to save her life.
- Citing her religious convictions, Patricia competently and repeatedly refused to consent to a blood transfusion.
- Her estranged husband, Luc Dubreuil, who was not a Jehovah's Witness, was contacted and he consented to the transfusion for her.
- Patricia's mother, also a Jehovah's Witness, supported her daughter's refusal, while Patricia's two brothers and her husband supported the transfusion.
Procedural Posture:
- Memorial Hospital petitioned the Florida circuit court for an emergency declaratory judgment to determine its authority to administer blood transfusions to Patricia Dubreuil against her will.
- The trial court found a compelling state interest in preventing the abandonment of Dubreuil's four minor children and entered a judgment authorizing the transfusions.
- Patricia Dubreuil, the patient, appealed this decision to the Florida Fourth District Court of Appeal.
- The Fourth District Court of Appeal affirmed the trial court's order in a 2-1 decision.
- Patricia Dubreuil then sought discretionary review from the Supreme Court of Florida.
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Issue:
Does the state's interest in protecting minor children from abandonment override a competent parent's constitutional right to refuse a lifesaving blood transfusion on religious grounds when there is a surviving parent who is legally presumed to assume custody?
Opinions:
Majority - Chief Judge Barkett
No. A competent person's constitutional right of privacy and religious freedom to refuse medical treatment is not overcome by the state's interest in protecting minor children without clear and convincing evidence of abandonment. Florida law presumes that a surviving natural parent will assume custody and responsibility for their children. The State failed to present any evidence to rebut the strong legal presumption that the children's father, Luc Dubreuil, would care for them in the event of Patricia's death. Furthermore, the Court established that a healthcare provider's role is to honor a patient's wishes; if the state's interests are to be asserted, the State Attorney must intervene and carry the heavy burden of proof, not the hospital.
Dissenting - Justice Overton
Yes. The court should recognize the rights of the innocent newborn child, who has a significant special need for a natural mother. The majority's decision effectively condones child abandonment if the mother's choice is based on religious reasons and denies the State the opportunity to protect the child's interests. The family's disagreement over the treatment and the fact that the mother's life could be easily saved are critical factors that the majority overlooks.
Dissenting - Justice McDonald
Yes. The state's compelling interest in protecting young children outweighs the mother's right to the free exercise of her religious beliefs. Children of tender years have a right to the nurturing of their mother, and parenthood inherently requires sacrifice that can, in some circumstances, limit one's right to live according to personal beliefs. The fundamental duty to nurture offspring is sufficiently great to justify overriding Mrs. Dubreuil's refusal of lifesaving treatment.
Analysis:
This decision significantly strengthens a parent's right to bodily autonomy and religious freedom in medical decision-making. It clarifies that the state's interest in protecting children is not a blanket justification for overriding a parent's rights and establishes a high evidentiary bar—clear and convincing proof of abandonment—that the state must meet. The ruling also reshapes the litigation process by shifting the burden of asserting state interests from healthcare providers to the State Attorney, thereby protecting hospitals from liability when they honor a patient's competent refusal of care and preventing them from being forced into an adversarial role against their own patients.
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