Mercy Hosp., Inc. v. Jackson, 88

• Decision Date: 01 September 1985
• Docket Number: No. 88,88
• Citation: 306 Md. 556,510 A.2d 562
• Parties: MERCY HOSPITAL, INC. v. Ernestine JACKSON. ,
• Court: Maryland Court of Appeals

Page 556

306 Md. 556

510 A.2d 562

MERCY HOSPITAL, INC. v. Ernestine JACKSON.

No. 88, Sept. Term, 1985.

Court of Appeals of Maryland.

June 30, 1986.

Michael J. Travieso (Christopher J. Fritz, Gallagher, Evelius & Jones, on brief) Baltimore, for appellant.

Barbara B. Mello, American Civil Liberties Union of Md., Baltimore, for appellee.

Argued before SMITH, ELDRIDGE, COLE, RODOWSKY, COUCH and McAULIFFE, JJ., and CHARLES E. ORTH, JR., Associate Judge of the Court of Appeals of Maryland (retired), Specially Assigned.

ELDRIDGE, Judge.

Mercy Hospital and Ernestine Jackson have asked us to answer some fundamental questions concerning the limits, if any, of Mrs. Jackson's constitutional right to refuse a blood transfusion. The case, however, is now moot. Furthermore, for reasons hereafter set forth, this is not one of those rare instances in which it would be appropriate for the Court to express its views concerning the merits of a moot controversy.

I.

Ernestine Jackson has been married for two years to Charles Jackson. At the time when the present controversy arose, she had no children but was pregnant. Mrs. Jackson and her husband are Jehovah's Witnesses. She was reared in that faith by her parents, has studied its tenets since the age of nine or ten, has been attending the Kingdom Hall Church for many years, and believes strongly in her religion.

When asked why she did not want to accept a blood transfusion, Mrs. Jackson answered, "Because of what I had learned from the Bible. It has, Jehovah always has told people straight from the Bible to sustain from blood." When asked if she would accept the risk of death rather than receive a blood transfusion, Mrs. Jackson said, "Yeah, because I do believe in Jehovah, and I know he will help me." Mrs. Jackson has had occasion to weigh her beliefs before--she had previously undergone surgery for a myoma of the uterus in connection with an earlier unsuccessful pregnancy which ended with premature labor. In addition, her mother apparently underwent surgical removal of a kidney without consenting to a blood transfusion. Mrs. Jackson discussed her views with all of her doctors after the onset of her pregnancy, and with four ministers on this particular occasion. She was aware that refusing the transfusion could very well result in death. ¹

On February 24, 1984, when she was about 25 weeks pregnant, Mrs. Jackson began to go into premature labor. She first went to University of Maryland Hospital in Baltimore. Unsuccessful in obtaining full treatment there without consenting to a blood transfusion, Mrs. Jackson on February 26th went to Mercy Hospital in Baltimore.

Her doctors found that her baby was lying in an oblique to transverse position with the placenta anterior and in the lower segment of the uterus. Dr. Joseph Morris, the Chief Resident of the OB/GYN service at Mercy Hospital, advised that the baby be delivered by Caesarian section for several reasons. The baby's position in the womb weighed against vaginal delivery. Vaginal delivery would expose the premature baby to birth trauma. Vaginal delivery would also pose a risk of a ruptured uterus in Mrs. Jackson's case, because her uterus had been weakened by earlier surgery to remove a myoma, a tumor consisting of muscle tissue. Whichever method of delivery was chosen, the risk of needing a blood transfusion was significant, because of the position of the placenta near the area where the Caesarian incision would be made, and because of the possibility of a ruptured uterus during labor. Dr. Morris testified that if Mrs. Jackson lost too much blood she would have cardiac arrest, and that it would not be possible to stop and review the decision not to give a transfusion with the family or the patient. He also stated that artificial blood products acceptable to Jehovah's Witnesses would not supply the needed hemoglobin.

Nevertheless, Mrs. Jackson refused to consent to a blood transfusion. Her husband Charles and her father-in-law were with her at the hospital. Charles Jackson took the position that he would accept any decision his wife chose to make and that he would support the infant if his wife died. Mr. Jackson, 25 at the time, is a high school graduate, is employed as an "assistant service manager" at a retail store, and shares a house with his parents.

Mercy Hospital then orally petitioned the Circuit Court for Baltimore City for appointment of a temporary guardian of the person of Mrs. Jackson with authority to consent on her behalf to any medically necessary blood transfusion. The Court appointed an attorney for Mrs. Jackson and held a hearing, at which the facts recounted above were elicited. The circuit judge declined to appoint a temporary guardian and ordered that no blood transfusion be given to Mrs. Jackson. Dr. Morris immediately delivered Mrs. Jackson's baby girl by Caesarian section without a blood transfusion, and both survived and have since been released from the hospital.

Thereafter, Mercy filed a written petition, nunc pro tunc, seeking appointment of a temporary guardian for Mrs. Jackson with authority to consent to a blood transfusion. On March 5, 1984, the trial judge issued a Memorandum and Order denying Mercy's petition. Mercy then appealed to the Court of Special Appeals.

Mrs. Jackson filed a motion in the Court of Special Appeals asking the court to dismiss the appeal as moot, arguing that because she had left Mercy Hospital, because she no longer requires the medical treatment at issue here, and because she is extremely unlikely to seek such treatment from Mercy Hospital again, there no longer exists a controversy between the parties for which the court could fashion a remedy. The Hospital contended that the issues presented could recur and should be decided. The Court of Special Appeals took this latter view, reached the merits, and affirmed the trial judge's decision. Mercy Hosp. v. Jackson, 62 Md.App. 409, 489 A.2d 1130 (1985). Thereafter we granted Mercy Hospital's petition for a writ of certiorari.

II.

In addition to the briefs and oral arguments by the parties, amici briefs have been filed by the State of Maryland and the University of Maryland Medical System Corporation. Both the merits of the case and the matter of mootness have been thoroughly briefed and argued.

Mercy Hospital and the amici urge that we decide the merits. Mercy's position is that Mrs. Jackson's First Amendment right to religious freedom must be balanced against various "state interests [which] include the preservation of life, the protection of innocent third parties such as minor and unborn children from the loss of a parent, and maintaining the ethical integrity of the medical profession." (Petitioner's brief p. 9). In Mercy's view, "the Court of Special Appeals erred in holding that [Mrs. Jackson's] religious claim outweighed the State of Maryland's interest in preserving [Mrs. Jackson's] own life, protecting the welfare of [her] child, and maintaining the integrity of the health care delivery system, including the integrity of Mercy Hospital and its staff." (Id. at pp. 9-10). The University of Maryland Medical System Corporation takes essentially the same position.

Counsel for Mrs. Jackson stated at oral argument that Mrs. Jackson has changed her view somewhat since filing in the Court of Special Appeals the motion to dismiss, and now believes that the merits of the case should be decided. Nonetheless, counsel frankly stated that she has serious doubts concerning the frequency with which these cases will arise, and that even if we reject Mercy Hospital's position in this case, Mercy and other hospitals will continue to seek court orders and will distinguish the instant case in light of its particular facts. In arguing for affirmance of the decisions below, Mrs. Jackson maintains that the "constitutional right of free exercise of religion forbids a state court to order a blood transfusion over the religious objection of a pregnant woman when only the life of the mother, not that of the fetus, is endangered." (Respondent's brief p. 7). Mrs. Jackson also relies upon the "constitutional right of privacy" as delineated in Griswold v. Connecticut, 381 U.S. 479, 85 S.Ct. 1678, 14 L.Ed.2d 510 (1965); Roe v. Wade, 410 U.S. 113, 93 S.Ct. 705, 35 L.Ed.2d 147 (1973), and other cases. In addition, Mrs. Jackson invokes the doctrine of "informed consent" recognized in Sard v. Hardy, 281 Md. 432, 379 A.2d 1014 (1977). The State of Maryland likewise contends that the decisions below were correct, relying upon Mrs. Jackson's constitutional right freely to exercise her religious beliefs and constitutional "right of bodily privacy."

III.

As this Court pointed out in Attorney Gen. v. A.A. School Bus, 286 Md. 324, 327, 407 A.2d 749 (1979), "A question is moot if, at the time it is before the court, there is no longer an existing controversy between the parties, so that there is no longer any effective remedy which the court can provide." It is undisputed that the present case is moot under this standard. There is no longer a controversy between Mercy Hospital and Mrs. Jackson over consent to a blood transfusion. Nothing that we say will bind the parties to any future course of action or will affect or remedy what has already taken place.

This Court has the constitutional authority to express its views on the merits of a moot case, Reyes v. Prince George's County, 281 Md. 279, 291-299, 380 A.2d 12 (1977). Nevertheless, as Judge Digges stated for the Court in Reyes, "we will exercise this authority only in rare instances which demonstrate the most compelling of circumstances." 281 Md. at 297, 380 A.2d 12.

Therefore, generally when a case becomes moot, we order that the appeal or the case be dismissed without expressing our views on the merits of the controversy. See, e.g., Comm'n On Human Relations v. Mass Transit, 303 Md. 416, 494 A.2d 210 (1985); County Comm'rs v. Secretary of Health, 302 Md. 566, 489 A.2d 1127...