Milton, In re

• Decision Date: 20 February 1987
• Docket Number: No. 86-1218,86-1218
• Citation: 29 Ohio St.3d 20,505 N.E.2d 255
• Parties: , 29 O.B.R. 373 In re MILTON.
• Court: Ohio Supreme Court

Page 20

29 Ohio St.3d 20

505 N.E.2d 255, 29 O.B.R. 373

In re MILTON.

No. 86-1218.

Supreme Court of Ohio.

Feb. 20, 1987.

Syllabus by the Court

1. The First Amendment to the United States Constitution and Section 7, Article I of the Ohio Constitution safeguard an individual's freedom to both choose and employ religious beliefs and practices.

2. The state may not compel a legally competent adult to submit to medical treatment which would violate that individual's religious beliefs even though the treatment is arguably life-extending.

This case arises from an application filed with the Court of Common Pleas of Franklin County, Probate Division, requesting authorization to perform medical treatment on appellant, Nancy Milton. The application, which was filed pursuant to R.C. 5122.271 ¹ by Dr. Lewis A. Lindner, the Chief Medical Officer of the Central Ohio Psychiatric Hospital (hereinafter "hospital"), alleged that appellant was unable to give informed, intelligent, and knowing consent for surgery. Dr. Lindner petitioned for an order requiring appellant to submit to radiation treatments, transfusions and possible surgery, stating that without these treatments, the patient would suffer an early death. ²

A hearing on the application was conducted in the probate court. ³ The hospital called two witnesses at this hearing, Dr. Lewis Lindner and Dr. Eugene Green, a psychiatrist. Dr. Green testified that appellant was alert, responsive, did not appear confused, and could function in many areas of everyday life. Dr. Lindner stated that she was of normal intelligence.

Appellant, a fifty-three-year-old patient of the hospital, refused to consent to this medical treatment primarily because it conflicted with her belief in faith healing. ⁴ Dr. Lindner claimed that appellant's stated reasons for refusing consent constituted a psychotic delusion and that she was unable to understand and appreciate the information necessary to either provide informed consent or to refuse such consent. Dr. Lindner asserted that appellant's entire belief system was delusional because she had a fixed long-standing delusion that she was the spouse of Rev. LeRoy Jenkins, a faith healer and evangelist who is well known in the central Ohio area.

Dr. Lindner conceded that appellant has never been adjudicated incompetent and that the hospital had accepted, without question as to her competency, her informed consent for all prior treatments at the hospital, including the biopsy through which the malignant tumor was diagnosed.

The trial court found that appellant had the mental capability to understand the nature of her illness and the contemplated treatment, but held that since appellant was not receiving spiritual treatment from Rev. Jenkins, the court could intervene. Therefore, the trial court authorized the requested medical treatment. The court of appeals affirmed, holding that appellant's beliefs in faith healing " * * * by all rational evaluation, constitute a delusion."

This cause is now before this court pursuant to the allowance of a motion to certify the record.

Anthony J. Celebrezze, Jr., Atty. Gen., J. Michael Evans, Columbus, for appellee Dept. of Mental Health.

Ronald L. Smith, Columbus, for appellant.

G. Michael Kirkman, Bruce A. Campbell, Columbus, urging reversal for amicus curiae, American Civil Liberties Union of Ohio Foundation, Inc.

WRIGHT, Justice.

This is a case of first impression in Ohio. Several difficult and delicate questions are before us, including whether a state acting through its courts may compel an individual to submit to medical treatment which is arguably life-extending in derogation of that individual's religious beliefs. We must also decide whether the court below infringed upon appellant's constitutional right of religious freedom in citing the essence of her belief in faith healing as evidence of her lack of capacity to provide informed consent to medical treatment. We believe these questions should be resolved in favor of appellant and, thus, we reverse the holding of the appellate court.

At the outset, we emphasize that at no time has any court found appellant to be incompetent under state law. Appellant is a voluntary patient of the hospital. However, even if she were to be involuntarily committed, that commitment would not be tantamount to a finding of incompetency. Commitments to a mental institution and adjudications of incompetency are distinct legal proceedings which determine separate issues and often lead to different results. Commitment proceedings focus on proof of dangerousness as the primary determinant of the need for commitment, while incompetency adjudications evaluate a person's cognitive ability to make decisions. ⁵ "[A] finding of 'mental illness' * * * and commitment to a hospital, does [sic ] not raise even a presumption that the patient is 'incompetent' or unable adequately to manage his own affairs." Winters v. Miller (C.A.2, 1971), 446 F.2d 65, 68. Thus, a person who is not in a mental institution may be found to be incompetent, and a person properly committed to a mental institution may be legally competent.

Persons admitted to mental hospitals retain all civil rights not specifically denied by statutes or removed by separate adjudications of incompetency. R.C. 5122.301. These civil rights include the right to sue or defend in one's own name, sell or dispose of property, marry, draft a will, freely practice one's religion, and refuse medical treatment for religious reasons. See Winters v. Miller, supra. In Winters, a case factually similar to our own, a Christian Scientist, who was committed to a mental hospital, but who had not been adjudicated incompetent, refused to consent to medical treatment on the basis of her religious beliefs. The court discussed the requirement that only a "[']grave and immediate danger to interests which the state may lawfully protect[']" (id. at 69) can justify a state's interference with the freedom of religion and held that "there is no evidence in the record that would indicate that in forcing the unwanted medication on Miss Winters the state was in any way protecting the interest of society or even any third party." Id. at 70. Thus, it is apparent that the state may not act in a parens patriae relationship to a mental hospital patient unless the patient has been adjudicated incompetent.

The fact that appellant has a long-standing delusion that she is Rev. Jenkins' wife and that he will perchance heal her infirmities simply does not strip appellant of her constitutional rights to freely select and adhere to the religion of her choice. The testimony of Dr. Green, the hospital's own witness, supports a conclusion that appellant's belief in spiritual healing stands on its own, without regard to her delusion. ⁶ Dr. Green explained that appellant's psychosis was "pretty much limited to delusional imaginations" and that "[c]ertain other parts of her seem pretty much intact."

The First Amendment to the United States Constitution and Section 7, Article I of the Ohio Constitution safeguard an individual's freedom to both choose and employ religious beliefs and practices. ⁷ See Bd. of Edn. of iCincinnati v. Minor (1872), 23 Ohio St. 211, 250. A person's religious beliefs are protected absolutely. Cantwell v. Connecticut (1940), 310 U.S. 296, 303, 60 S.Ct. 900, 903, 84 L.Ed. 1213. The state may not interfere with the expression of belief, nor may it "compel behavior offensive to religious principles." (Emphasis deleted.) School Dist. of Abington Twp. v. Schempp (1963), 374 U.S. 203, 250, 83 S.Ct. 1560, 1586, 10 L.Ed.2d 844 (Brennan, J., concurring).

While religiously inspired acts do not receive absolute protection, " * * * [o]nly the gravest abuses, endangering paramount interests, give occasion for permissible limitation." Thomas v. Collins (1945), 323 U.S. 516, 530, 65 S.Ct. 315, 323, 89 L.Ed. 430; Sherbert v. Verner (1963), 374 U.S. 398, 406, 83 S.Ct. 1790, 1795, 10 L.Ed.2d 965; see, also, Wisconsin v. Yoder (1972), 406 U.S. 205, 215, 92 S.Ct. 1526, 1533, 32 L.Ed.2d 15. Freedom of religion may be infringed "only to prevent grave and immediate danger to interests which the State may lawfully protect." West Virginia State Bd. of Edn. v. Barnette (1943), 319 U.S. 624, 639, 63 S.Ct. 1178, 1186, 87 L.Ed. 1628.

Appellee does not suggest any state interest sufficient to justify interfering with appellant's religiously inspired refusal to consent to medical treatment. Appellee argues that appellant's delusion that she was Rev. Jenkins' spouse negated her religious views and made her entire belief in faith healing a delusion. The court of appeals looked to the content of appellant's religious beliefs and found that her belief in faith healing constituted a delusion. We do not accept this contention.

There is a dichotomy between modern medicine which is scientific and based upon provable theories and religion which is inherently mystical, intangible and a matter of individual faith. Yet, the Ohio and United States Constitutions mandate that when the dictates of modern medicine and religious beliefs collide, the conflict be resolved by leaving the medical treatment decision to the individual. As the court stated in United States v. Ballard (1944), 322 U.S. 78, 86, 64 S.Ct. 882, 886, 88 L.Ed. 1148, freedom of religion "embraces the right to maintain theories of life and of death and of the hereafter which are rank heresy to followers of the orthodox faiths. * * * Men may believe what they cannot prove. They may not be put to the proof of their religious doctrines or beliefs. Religious experiences which are as real as life to some may be incomprehensible to others."

While there may be a variety of opinions as to the efficacy of spiritual healing through faith, the courts below acknowledged that it is a form of religious belief and practice. We recognize that extending constitutional protection to a belief in spiritual healing and other...