Mercy Hospital, Inc. v. Jackson

⁴¹¹ GILBERT, Chief Judge. In this appeal we are asked to determine whether a competent, conscious, rational adult may be required, in spite of religious beliefs, to submit to a blood transfusion. Ernestine Jackson was admitted to Mercy Hospital on an emergency basis on February 26, 1984. Mrs. Jackson was 25 or 26 weeks into her pregnancy and was undergoing premature labor.

The examination of Mrs. Jackson by Mercy’s medical staff revealed that a routine vaginal delivery would create serious and dangerous medical complications for both Mrs. Jackson and the unborn child. The fetus was lying in the womb in an “oblique to transverse position,” and the risk of a ruptured uterus was great because Mrs. Jackson had previously undergone a myomectomy 1 because of her having given birth prematurely on a prior occasion. Mercy’s diagnosis suggested an abdominal, or Caesarean section, delivery. A Caesarean delivery is a relatively safe and routine, albeit surgical, form of childbirth.

The most serious drawback — the surgical intervention prescribed in the matter now before us — is that the mother inevitably loses a certain, but not predeterminable, quantity of blood. In the instant case, it was the contemplated loss of blood together with the attendant risks that injected the legal profession into an otherwise sterile medico-monopolistic delivery room. We explain. Mrs. Jackson is by religious persuasion a Jehovah’s Witness.

One of the tenets of that faith is that a believer may not, under any circumstances, receive blood transfusions. Members of Mercy’s medical staff counselled Mrs. Jackson that there was a 40 to 50 percent chance she would need a transfusion. If that need developed and if there were no transfusion, the doctors told her that they thought it likely she would die during a Caesarean delivery. Mrs. Jackson, nevertheless, steadfastly refused to compro ⁴¹² mise her religious beliefs.

She requested that the Caesarean delivery proceed 2 without blood transfusions. Mrs. Jackson’s husband was with his wife at Mercy and he, also a Jehovah’s Witness, wholeheartedly supported her position. Mercy adjudged the risk that Mrs. Jackson had assumed to be medically unacceptable. As a result, its counsel immediately orally petitioned the Circuit Court for Baltimore City (Greenfeld, J.) for the appointment of a guardian for Mrs. Jackson with authority in the guardian to consent to blood transfusions to Mrs. Jackson.

Judge Greenfeld appointed counsel for Mrs. Jackson and then convened a court hearing at her bedside in the hospital. Some physicians on Mercy’s staff testified with respect to the life threatening condition that Mrs. Jackson was precipitating as a result of her steadfast refusal to be transfused. Mrs. Jackson and her husband told Judge Greenfeld of their firm religious convictions and their decision to proceed with the surgical intervention, sans transfusion, despite the potentially fatal risk entailed. Judge Greenfeld denied Mercy’s application for guardianship, and the operation occurred without the use of transfusions.

Mrs. Jackson and her child survived the surgery. It is from the denial of the appointment of a guardian for Mrs. Jackson that Mercy brings this appeal and posits to us the single question: “Did the ... [circuit] court err in holding that a competent, pregnant adult has a paramount right to refuse consent to a blood transfusion on the basis of her religious beliefs in the circumstances presented in this case?” The hospital vigorously contends that the “sole issue” before this Court devolves to deciding whether Judge ⁴¹³ Greenfeld erred as a matter of law in balancing certain competing State interests 3 against Mrs. Jackson’s right to freedom of religion under the First Amendment to the Constitution of the United States, and then finding in Mrs. Jackson’s favor. Viewing the matter from an entirely different perspective, Mrs. Jackson has moved to dismiss this appeal because there is no actual controversy between the parties; there is no remedy which this Court may fashion between Mercy and Mrs. Jackson. Patently, Mrs. Jackson has already undergone the surgery.

In her words, she “no longer requires medical attention of the sort at issue here, and if she did, would be extremely unlikely to seek it from [Mercy Hospital].” In sum, Mrs. Jackson states that the issue is moot and should be dismissed. Md.Rules 1035 b. 8 and 1036 d. The threshold issue in the matter at bar is, inescapably, that of mootness. Inasmuch as the surgery was concluded, the child born, and the patient discharged, this case would ordinarily be found not judiciable.

See Hamilton v. McAuliffe, 277 Md. 336 , 353 A.2d 634 (1976). Mercy and the Attorney General 4 urge that we not dismiss the appeal for mootness, but that we address it because the issue is likely to arise again and again. Because of the probability of repetition and the substantial likelihood that the matter will always be moot by the time it reaches an appellate court, we deem it to be in the public interest for us to answer Mercy’s question. See Coleman v. Coleman, 57 Md.App. 755, 758 , 471 A.2d 1115, 1117 (1984).

Mercy Hospital argues to this Court that, “Mercy is a private, non-profit, Catholic hospital which is run by the Sisters of Mercy, a Catholic religious order,” and that it is ⁴¹⁴ affiliated with the Roman Catholic Church in the United States. Despite the absence of testimony to that effect before the circuit court, Mrs. Jackson has stipulated that the hospital’s self-portrayal is accurate. Mercy says that it “is dedicated to the preservation of life and family through the provision of medical services____” Nevertheless, Mercy may not properly complain that Mrs. Jackson’s religious beliefs were upheld to the detriment of the hospital’s own religious convictions. 5 The State, in this case personified by the circuit court judge, must “be a neutral in its relations with groups of religious believers and non-believers.” Atlantic Department Store, Inc. v. State’s Attorney, 22 Md.App. 381, 387 , 323 A.2d 617, 620 (1974), citing School District of Abington Tp. Pa. v. Schempp, 374 U.S. 203 , 83 S.Ct. 1560 , 10 L.Ed.2d 844 (1963) (also cited as Murray v. Curlett); Cantwell v. Connecticut, 310 U.S. 296 , 60 S.Ct. 900 , 84 L.Ed. 1213 (1940).

Freedom of religion means the right to pursue one’s religious beliefs without interference from any other religion, non-religion or the government. Montgomery County Department of Social Services v. Sanders, 38 Md.App. 406 , 416 n. 10, 381 A.2d 1154 , 1161 n. 10 (1978) (citations omitted). “No chapter in human history has been so largely written in terms of persecution and intolerance as the one dealing with religious freedom. From ancient times to the present day, the ingenuity of man has known no limits in its ability to forge weapons of oppression for use against those who dare to express or practice unorthodox religious beliefs. And the Jehovah’s Witnesses are living proof of the fact that even in this nation, conceived as it ⁴¹⁵ was in the ideals of freedom, the right to practice religion in unconventional ways is still far from secure.” Prince v. Massachusetts, 321 U.S. 158, 176-76 , 64 S.Ct. 438, 447 , 88 L.Ed. 645, 657 (1944) (Murphy, J., dissenting).

Although the First Amendment 6 precludes the State from interfering with the religious beliefs of its citizens, the State may nevertheless intervene in those instances where a compelling State interest is jeopardized by a practice generated by a religious impetus. See McMillan v. State, 258 Md. 147 , 265 A.2d 453 (1970). For example, the State’s interest in the safety and well-being of minors may compel medical treatment for a child despite objections by the parents that are based upon their