In an important case concerning personal autonomy, the Montana Supreme Court stayed an alarming order from Montana state judge for a woman to be forced to undergo an hysterectomy to save her life.
Last Tuesday, Judge Karen Townsend ruled that the woman L.K. was mentally incompetent and ordered that she be forced to have the surgery as recommended by her doctor. She heard testimony from a psychiatrist and found that the L.K. was experiencing “religious delusions.”
However, it is not clear where the court draws the line between legitimate religious beliefs and religious delusions. Many atheists and agnostics view all religion as a delusion while many adults believe strongly that only God can heal them.
The Constitution protects the right of people to make these choices — even at the risk of their own lives. We draw the line at children, who are often the subject of orders for life-saving medical care over the objections of religious parents.
If however an individual is incompetent, the court does have authority to make such decisions. Generally, however, such individuals cannot function in public and are in state hospitals. The concern is whether a court can treat the religious belief (vis-a-vis the surgery) as the evidence of religious delusion.
Judge Townsend may ultimately be upheld if the record can establish that the women is incompetent and cannot make decisions for herself.
Source: Missoulian
Jonathan Turley
I live in Nova Scotia Canada and have a 31 year old nephew who was recently diagnosed with Non hodgkin’s Lymphoma, that is curable. The doctors want to do a bone marrow biopsy and a PET Scan. He is refusing treatment and tests. The doctor say there is nothing they can do. My nephew prior to this was in the pysch ward for evaluation and was deemed pschotic. He also thinks he has figured out the meaning and secret to life and now that he knows that he must die. That is God’s Plan. I would love to have LK’s doctor here in Nova Scotia to step in and save this boys life. I feel he is incompetant to make this medical choice as I do in LK’s situation. If the end goal is death then why not commit suicide why prolong the inevidable. My answer is because deep down inside lies the will to live but they are so incopaitated by the cancer, diagnosis, tests, fears whatever that they can’t make a rational informed decision, otherwise they would just kill themselves wouldn’t they. I mean suicide is against relifgious beliefs but isn’t neglecting treatment a prolonged suicide?
“I guess, in the big picture, the best policy is to allow marginally mentally ill people to harm themselves without state intervention.
tomdarch,
I agree with you and acknowledge that the facts may not be all there, which is why I made my statement conditionally. Knowing the mental health community as I do and having spent the last three decades being treated medically for severe illness, I am well aware that not all M.D.’s, Psychiatrists, PsyD’s and other professionals are not always right and all to frequently wrong. Given that i think that the patient’s will should be controlling.
That’s why I’ve never understood the prohibitions against suicides, providing no one else is physically affected by the act. Despite false characterizations by the propaganda machine, those who believe in civil liberties are not always lockstep with government interventions.
Just to summarize my comment above: when you read the “facts as presented” in the summary of a case involving the intersection of an individual’s physical and mental health, you might think, “Oh, this is a clear cut situation with a perfectly reasonable problem/issue.” But the people who get to speak with or hear from that individual at length may be given reason to conclude that the seemingly simple, reasonable situation is complicated by the other-than-sane state of that individual’s mind.
I love it when evangelicals make their own medical decisions. Darwin always has the last laugh.
More of this, please.
Sorry for misspelled words in my above post. I have much difficulty seeing….
Hysterectomy is a hoax. It is only life-saving approximately 1 % ot the time. It is big business for doctors and drug companies. In 1985, the U.S. Supreme Court ruled it constituted ‘cruel and unusual’ punishment to surgically castrate convicted sex offenders. Yet, American gynecologists castrate over half a million women each year; women who have commited no crime. The number of women being hysterectomized and castrated is indicitive of the fact that something very wrong and immoral is going on here. Over half a million women each year ‘need’ to be gutted and catrated… not likely.
My own horrific story is very telling of what is really going on here period. I was a healthy, attractive young 46 year old who went to a gynecologist with an issue of my abdomen swelling to the size of a woman nine months pregnant. An MRI was performed, a transvaginal ultrasound and uterine lining biopsy performed, etc, All tests were normal. I did not have insurance at my first visit due to having recently changed jobs. The gynecologist told me that I had a prolapsed uterus which is common for any woman who has had children via vaginal delviery. He told me that if I ever had problems from the prolapse, I could use a ring to hold my uterus in place. I was engaged at the time and planning to have another baby and the doctor knew this. He did not seem to think anything major needed to be done at this time.
However… once my insurance kicked in, the gynecologist suddenly decided that I needed a hysterectomy in order to ‘cure’ my deformed abdomen. I finally agreed to allow him to go in with a light and look around my abdomen in order to see if he could find the cause of my abdominal deformity/sweling and I agreed to allow him to remove my uterus ONLY; not even possible removal of any other organs. The female sex organs are an important part of the endocrine system and mine had already been compromised due to a pituitary tumor at 15 and trauma which caused my adrenal glands to fail. Even the gynecologist agreed with me (in his office at the pre-surgery visit) that it would be better to err on the side of caution and not remove my ovaries or cervix. I took my fiance with me to this meeting as a witness.
I arrived at the hospital two days later and I was presented with a new consent form which allowed for the removal of all six of my healthy sex organs. I refused to sign the consent and told the nurse I did not want to have any surgery perfomed and asked to speak to my doctor. Shortly thereafter, a nurse ‘acting’ as an M.D. came into my room and stated that he was going to give me someting to relax me a little but not put me to sleep since I had not signed the consent and was waiting to speak with my doctor. My mother, fiance and oldest son were there with me at this time and witnessed this. The nurse injected something into my IV and that was my last waking memory. i was quickly taken to surgery and gutted and castrated.
When I woke up, I did not realize I had had surgery. I thought I was still waiting to speak with the doctor. A nurse told me that I had had surgery and that all of my sex organs had been amputated. I began crying and yelling that I wanted to die. This is all documented in my hospital record. The nurses wanted to put me on suicide watch but the doctor merely told my mother to stay the night with me to make sure I did not kill myself until he could release me the next morning.
I have lost much of my vision due to the formation of cataracts from the loss of estrogen to my lenses. Two eye doctors have told me that I now have the eyes of 70 year old which will require surgery at some poih in my near future. I can’t see to drive at night now and I have trouble driving during the day. I have thyroid disease due to loss of estrogen due to the thyroid having estrogen receptors. My bladder, bowels and intestines have all become displaced due to auppoer system being removed. I have to urinate about every fifteen minutes day and night so I’m pretty much tied to being home. My bones and joints ache very badly. I have major lower back pain now. I am asexual and have no sexual desire and no sexual sensation or ability to have anything remotely similar to an orgasm as I had before the surgery. At least a third of my vagina was taken along with my organs (which is quite common with vaginal hysterectomies and the top of my vagina was sewn shut like a closed pocket). I have chronic fatigue since the surgery. Before the surgery, I had lots of energy and worked out every day. I now have insomnia. I can’t have a bowel movement without spending $100 month on an herb that helps me to have one. I have lost control of my own bodily functions.
I did not marry and I am no longer able to work due to all the physical and mental problems I endure as a direct result of a sugery I did not need nor consent to. And… my stomach is still deformed. I receive disability but it is not enough to support myself so I have been homeless for two years now. I pay $300 every three months for a hormone implant and I take a hormone and many supplements by mouth. I don’t have insurance or a medical card. My medical card was taken from me once I began receiving disability.
In short, my life is not worth living. I’ve lost everything and for no reason other than a greedy criminal doctor who has a license to butcher women. I consider him to be nothing short of a serial killer… I also have suicidal depression that, so far, can’t be fixed with medication. I attempted to hang myself in my closet just five months after my surgery and I have made many attempts since that time.
In short, the human body is not a warehouse of organs nor is it a machine. The body is inherent to the individual who has the inalienable right to defend its integrity while alive and bury it whole. I was told at age 15 by my endocrinologist that I would likely never be able to have children but he was a very caring and conservative doctor and opted not to operate on my tumor. He kept watch on me and waited until there was a medication available in the U.S. that would hopefully shrink my tumor. It worked and I had three children. I thank God today for a doctor who was truly committed to ‘do no harm’.
What happened to this woman is wrong wrong wrong…. Every man and woman should cry out on this woman’s behalf. I can say first-hand and from talking with hundreds of women throughout the U.S. that the removal/amputation of the sex organs of a woman drastically changes the quality of her existence irreversibly. It influences and denies her intimate needs and rights, her rights of choice, her claim to an autonomous sexual subjectivity and, most importantly, the rights over her own body. We should all be very afraid…..
And this is different from suicide by “normal” people how? It used to be a crime to commit suicide and people could be hospitalized without their consent if it was deemed they were likely to harm themselves or others.
This woman doesn’t sound reasonable to want to produce a child when she’s been told she will be dead in three years, but whoever said reasonable is the guiding principle for having children?
Mike Spindell 1, March 8, 2011 at 12:44 pm
With the facts as presented I think the court has overstepped itself.
——————————
Maybe I’m reading things in that aren’t there, but I suspect that a HUGE amount isn’t part of the “facts as presented.”
For a psychiatrist to testify that (s)he believes that a person is so delusional that they can’t make important medical decisions, it strongly suggests that this person said a lot of very, very crazy stuff. Not every seriously mentally ill person is an unwashed, mumbling homeless person, or a character from the film version of “One Flew Over the Cuckoo’s Nest.” In addition to speaking directly with L.K., I expect that the psychiatrist is basing his/her decision on a review of her medical history, and possibly talking with her friends (if any) and family (if they are available and willing to talk).
Just because a delusion can be summed up with a statement like, “It’s against my religion,” doesn’t mean that there isn’t a whole seething mass of crazy behind that statement.
Come to think of it, the fact that there is no report of comments from L.K.’s family leads me to further suspect that she may be mentally ill. I’m certain that if my sister was at risk of having a forced surgery, my parents and I would be shouting from every rooftop to protect her. On the other hand, a family with a severely mentally ill person would likely keep quiet in these circumstances.
My point here is that if L.K. is seriously mentally ill, I think it is likely that the “facts as reported” in the framework of a court case would not tell the full medical story. We just don’t know.
I guess, in the big picture, the best policy is to allow marginally mentally ill people to harm themselves without state intervention. Once in a while, they will harm “innocent bystanders,” but as with our criminal system, the best set of trade-offs is probably to do nothing except when there is very strong proof.
I wouldn’t want to denigrate doctors, but they don’t always have the right answer for everything, even if sometimes, they assume the role of Highest Authority. I firmly believe this particular operation would be beneficial for the patient but ongoing medical research has demonstrated that what is proven today can certainly be in error tomorrow. Bloodletting and leeches come to mind, as does “every woman over 50 should be on hormone pills,” “coffee is good for you this week,” and “coffee is bad for you this week.”
The right of dominion over one’s body would seem to be elemental and sacred, government experts notwithstanding.
With the facts as presented I think the court has overstepped itself. The definitions of irrationality and who’s crazy are writtenin sand, despite the claims of those in particular pschological/psychiatric field. I have worked with people dignosed as raving schizophrenics, who seemed to me only the makers of bas choices and in some cases not even that.
“Eugenics and forced sterilization anyone?”
Is to me a fair comment by Erykah.
Eugenics and forced sterilization anyone?
Great work Elaine,
This case is getting crazier and crazier. It was interesting that the court appointed doctor never filed a report. I am glad the Montana Supreme Court put this on hold until the facts can really be uncoverd.
From WSJ Law Blog
March 7, 2011
Court-Ordered Hysterectomy Put on Hold . . . For Now
http://blogs.wsj.com/law/2011/03/07/court-ordered-hysterectomy-put-on-hold-for-now/?mod=google_news_blog
Excerpt:
The backstory goes like this: Last September, after L.K.’s cancer diagnosis, a doctor sent a letter to the Missoula County attorney’s office expressing concerns that L.K. might not be able to make medical decisions on her own. A petition to appoint a temporary medical guardian was filed in November. On Feb. 11, the temporary medical guardian signed a consent form for L.K. to have the radical hysterectomy. According to the AP story:
During a status hearing on March 1, a psychiatrist from the Montana State Hospital testified that the woman was having religious delusions that God had cured her and that those delusions prevented her from making fully informed decisions about her medical care.
A state hospital physician testified that the woman’s cancer was in stage 1 and that without treatment, there was an 85 percent chance it could kill her within three years. The physician also testified that it was possible, although not probable, for L.K. to have a child at her age. The court record does not include her age.
L.K. testified that she did understand she had been diagnosed with cancer and did understand the risks of dying without treatment. Her attorney argued that what the state characterized as delusions are actually L.K.’s deeply held religious beliefs.
A day after Townsend made her ruling, L.K.’s public defender filed an emergency petition with the Supreme Court arguing Townsend’s ruling violates L.K.’s religious freedom, bodily integrity and constitutional right to dignity. Greg Hood argued his client faced irreversible harm if the surgery went on as scheduled.
*****
Excerpt from L.K.’s motion:
http://searchcourts.mt.gov/view/OP%2011-0100%20Writ%20-%20Supervisory%20Control%20–%20Petition?id={6CBAA807-BF1B-4C66-A180-C8FC190F7D8C}
FACTUAL AND PROCEDURAL BACKGROUND
On September 2, 2010, Dr. Valerie Knutsen sent a letter to the Missoula
County Attorney’s office indicating concerns about L.K.’s competence to make
medical decisions after cancerous cells were found on her cervix, a radical
hysterectomy was recommended, and L.K. expressed reluctance to have the
surgery because she wanted children. On September 3, 2010, Kim Peterson,
APRN, sent a similar letter to the Missoula County Attorney’s office questioning
L.K.’s competence, stating that L.K. stated it was “against her religion” to have
that type of surgery. On October 18, Peterson sent another similar letter. The
Petition for Determination of Incapacity and Appointment of a Temporary Medical
Guardian was filed on November 17, 2010, as DG-10-131. On that same day, the
district court without any further proceedings signed an order appointing a
temporary guardian with authority to authorize surgery. The district court then set
a show cause hearing for December 7, 2010.
After two continuances by the State because no Visitor or Physician’s
Reports had been filed, on January 11, 2011, the district court ordered that Dr.
Elrod be appointed as Physician and Janet Hinze as Visitor. A Visitor’s Report
from Hinze was filed January 11, 2011. No report from the court-appointed
physician, Dr. Elrod, has ever been filed. On February 11, 2011, the Temporary
Medical Guardian signed a consent form for L.K. to have the radical hysterectomy.
The surgery was scheduled for March 3, 2011.
At a February 22, 2011, status hearing, the district court granted L.K.’s
motion to cancel the surgery until the guardianship case had been fully adjudicated.
(2/22/11 minute entry, attached as Ex. A.) In a February 24, 2011, written order
the district court “ordered that the hysterectomy currently scheduled for March 3,
2011, be cancelled and that there be no further medical procedures scheduled by
the current temporary guardian until such time as the above entitled case can be
fully adjudicated and the Respondent’s capacity determined.” (2/24/2011 Order,
attached as Ex. B.) The district court set a “status” hearing in the case for March 1, 2011, and ordered that the yet to be filed court-appointed physician’s report was
due to the court prior to that date. On February 24th, Drs. Caddell and Knutsen—
neither of who is the court-appointed physician—submitted letters opining that
L.K. was incapable of making her own medical decisions.
This is unfortunate….The Court in cases like these has to look at the “Best Interest Factor” of the person that is subject to its jurisdiction….. However some things are not within the Discretion of the Court, even though this is probably the correct thing to do to abate cancer in this instance…. it is not the correct thing to do if they do not want it…. Then the next question is…. when does the court not exercise its authority when necessary….
If this woman is competent that should answer all questions. With a professional review of her ability to comprehend what is happening, I think the Montana Supremes were correct in slowing the process down. Especially if the cancer is not yet at a critical stage. If this woman is competent and the court decides to allow the hysterectomy, then this will be anoher watershed moment in the War on Women.
“”L.K. then testified on her own behalf that she did understand that she had been diagnosed with cancer and that she did understand the risks of dying if she did not have the hysterectomy procedure,” the petition said.
She also said that she might change her mind later about following her doctors’ recommendations.”
I don’t know about anyone else, or if I missed something, but the above indicates to me that this woman knows the risks involved and is open to changing her mind if need be. I fail to see how she can be declared incompetent based solely on her religious beliefs.
If she refused treatment down the line? So be it. IMHO, the decision is to be made between her and her doctor, and no one else. It’s called “privacy.”
Oh come on … this woman isn’t agreeing to go along with something others think is good for her so she’s incompetent?
According to reports she claims to understand the situation and has even suggested she might change her mind as time progresses … in other words, maybe she needs time to think about it … get second and third opinions. The judge ordered her to get the operation in TWO days.
Frank, the reason an exception is made in the case of children is that they are not acting out their own religous beliefs, but are subjected to those of their parents.
The physician testified at a March 1 hearing that without treatment, L.K.’s cancer could kill her within three years.
Three years? And she wants to have children. That sounds rational to me.
I’m not clear why an exception is made in the case of children. It seems the state has to stay out of the business of deciding the correctness or worth of religious ideas. If that means people want to kill themselves or their family we may have to let them, constitutionally. How do you draw that line?
It would be a self-correcting problem to just allow the religiously insane to refuse treatment.