Strunk Ex Rel. Burton v. Strunk
35 A.L.R. 3d 683, 1969 Ky. LEXIS 151, 445 S.W. 2d 145 (1969)
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Rule of Law:
A court of equity has the inherent power under the doctrine of substituted judgment to authorize the removal of an organ from an incompetent ward for transplantation into a family member, provided the court determines the procedure is in the best interest of the incompetent donor.
Facts:
- Tommy Strunk, 28, was suffering from chronic glomerulus nephritis, a fatal kidney disease, and required a kidney transplant to survive.
- His brother, Jerry Strunk, 27, was legally incompetent with a mental age of approximately six years and was a patient at a state institution for the feeble-minded.
- After the entire family was tested, Jerry was found to be the only family member who was medically acceptable as a live kidney donor for Tommy.
- Psychiatric testimony established that Jerry was greatly dependent on Tommy emotionally and psychologically.
- A psychiatrist testified that Tommy's death would have an 'extremely traumatic effect' on Jerry's well-being and that Tommy's life was vital to Jerry's stability and potential for improvement.
Procedural Posture:
- Ava Strunk, as committee for her son Jerry, petitioned the county court for authority to proceed with the kidney transplant operation.
- The county court found the operation necessary and beneficial to Jerry, and granted the authority.
- A guardian ad litem, representing Jerry's interests, appealed the decision to the Franklin Circuit Court (a state trial court of general jurisdiction).
- The Franklin Circuit Court chancellor affirmed the county court's order.
- The case was then appealed to the Court of Appeals of Kentucky, the state's highest court at the time, for final review.
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Issue:
Does a court of equity have the inherent power to authorize the removal of a kidney from an incompetent ward of the state for the purpose of transplanting it into his brother, who is dying of a fatal kidney disease?
Opinions:
Majority - Osborne, Judge
Yes. A court of equity, exercising its inherent parens patriae jurisdiction, has the power to authorize the transplant. The court invoked the doctrine of substituted judgment, which permits a chancellor to deal with the affairs of an incompetent in the same manner as the incompetent would if he had his faculties. The court found substantial evidence that the operation was in Jerry's best interest, as his well-being was deeply connected to his brother's survival. The potential psychological trauma to Jerry from Tommy's death outweighed the minimal physical risk of the nephrectomy, making the procedure beneficial to Jerry himself.
Dissenting - Steinfeld, Judge
No. A court of equity does not have the authority to permit the removal of an organ from an incompetent for the benefit of another. The power of a committee is restricted to protecting the ward and his property, not donating parts of his body. The asserted psychological benefit to Jerry is 'nebulous' and speculative, while the surgical risk is real. The decision creates a dangerous precedent that could lead to the exploitation of incompetent individuals. The court should not authorize such a procedure unless it is conclusively demonstrated to be of significant benefit to the incompetent, a standard which was not met here.
Analysis:
This case is a landmark decision in bioethics, establishing the legal foundation for organ donation by an incompetent individual. It significantly expanded the doctrine of 'substituted judgment' from matters of property to profound medical decisions involving bodily integrity for the benefit of another. The court's broad interpretation of 'best interest' to include psychological and emotional well-being has been highly influential in subsequent cases concerning medical treatment for minors and incompetents. The ruling frames the debate by balancing the physical risk to the incompetent donor against the psychological benefit they derive from the recipient's continued life.
