E.G., In re

Page 322

549 N.E.2d 322

133 Ill.2d 98, 139 Ill.Dec. 810, 58

USLW 2321

In re E.G., a Minor (The People of the State of Illinois, Appellant, v. E.G., a Minor, Appellee).

No. 66089.

Supreme Court of Illinois.

Nov. 13, 1989.

Rehearing Denied Jan. 29, 1990.

Neil F. Hartigan, Atty. Gen., Springfield, Richard M. Daley and Cecil A. Partee, State's Attys., Chicago (Terence M. Madsen, Asst. Atty. Gen., Chicago, and Thomas V. Gainer, Jr., Kenneth T. McCurry, Kim A. Novi, Inge Fryklund, Renee Goldfarb and James E. Fitzgerald, Asst. State's Attys., of counsel), for people.

Jane M. Whicher, Harvey Grossman and Diane Geraghty, Chicago, for appellee.

Donald T. Ridley, Brooklyn, New York, for amicus curiae Watchtower Bible and Tract Society of New York, Inc.

Justice RYAN delivered the opinion of the court:

Appellee, E.G., a 17-year-old woman, contracted leukemia and needed blood transfusions in the treatment of the disease. E.G. and her mother, Rosie Denton, refused to consent to the transfusions, contending that acceptance of blood would violate personal religious convictions rooted in their membership in the Jehovah's Witness faith. Appellant, the State of Illinois, filed a neglect petition in juvenile court in the circuit court of Cook County. The trial court entered an order finding E.G. to be neglected, and appointed a guardian to consent to the transfusions on E.G.'s behalf.

The appellate court reversed the trial court in part. The court held that E.G. was a "mature minor," and therefore could refuse the blood transfusions through the exercise of her first amendment right to freely exercise her religion. Nevertheless, the court affirmed the finding of neglect against Denton. 161 Ill.App.3d 765, 113 Ill.Dec. 477, 515 N.E.2d 286.

We granted the State's petition for leave to appeal and now affirm the appellate court's decision in part, but on other grounds. We also remand this case to the trial court for the purpose of expunging the finding of neglect.

In February of 1987, E.G. was diagnosed as having acute nonlymphatic leukemia, a malignant disease of the white blood cells. When E.G. and her mother, Rosie Denton, were informed that treatment of the disease would involve blood transfusions, they refused to consent to this medical procedure on the basis of their religious beliefs. As Jehovah's Witnesses, both E.G. and her mother desired to observe their religion's prohibition against the "eating" of blood. Mrs. Denton did authorize any other treatment and signed a waiver absolving the medical providers of liability for failure to administer transfusions.

As a result of Denton's and E.G.'s refusal to assent to blood transfusions, the State filed a neglect petition in juvenile court. At the initial hearing on February 25, 1987, Dr. Stanley Yachnin testified that E.G. had approximately one-fifth to one-sixth the normal oxygen-carrying capacity of her blood and consequently was excessively fatigued and incoherent. He stated that without blood transfusions, E.G. would likely die within a month. Dr. Yachnin testified that the transfusions, along with chemotherapy, achieve remission of the disease in about 80% of all patients so afflicted. Continued treatment, according to Dr. Yachnin, would involve the utilization of drugs and more transfusions. The long-term prognosis is not optimistic, as the survival rate for patients such as E.G. is 20 to 25%.

Dr. Yachnin stated that he discussed the proposed course of treatment with E.G. He testified that E.G. was competent to understand the consequences of accepting or rejecting treatment, and he was impressed with her maturity and the sincerity of her beliefs. Dr. Yachnin's observations regarding E.G.'s competency were corroborated by the testimony of Jane McAtee, the associate general counsel for the University of Chicago Hospital. At the conclusion of this hearing, the trial judge entered an order appointing McAtee temporary guardian, and authorizing her to consent to transfusions on E.G.'s behalf.

On April 8, 1987, further hearings were held on this matter. E.G., having received several blood transfusions, was strong enough to take the stand. She testified that the decision to refuse blood transfusions was her own and that she fully understood the nature of her disease and the consequences of her decision. She indicated that her decision was not based on any wish to die, but instead was grounded in her religious convictions. E.G. further stated that when informed that she would undergo transfusions, she asked to be sedated prior to the administration of the blood. She testified that the court's decision upset her, and said: "[I]t seems as if everything that I wanted or believe in was just being disregarded."

Several other witnesses gave their opinions extolling E.G.'s maturity and the sincerity of her religious beliefs. One witness was Dr. Littner, a psychiatrist who has special expertise in evaluating the maturity and competency of minors. Based on interviews with E.G. and her family, Dr. Littner expressed his opinion that E.G. had the maturity level of an 18 to 21 year old. He further concluded that E.G. had the competency to make an informed decision to refuse the blood transfusions, even if this choice was fatal.

On May 18, 1987, the trial court ruled that E.G. was medically neglected, and appointed a guardian to consent to medical treatment. The court felt this was in E.G.'s best interests. The court did state, however, that E.G. was "a mature 17-year-old individual," that E.G. reached her decision on an independent basis, and that she was "fully aware that death [was] assured absent treatment." The court noted that it considered E.G.'s maturity and the religion of her and her parents, and that it gave great weight to the wishes of E.G. Nevertheless, the court felt that the State's interest in this case was greater than the interest E.G. and her mother had in refusing to consent to treatment. The court concluded its ruling by encouraging E.G. to appeal.

On appeal, the order of the trial court pertaining to E.G.'s right to refuse treatment was vacated in part and modified in part. (161 Ill.App.3d 765, 113 Ill.Dec. 477, 515 N.E.2d 286). The appellate court observed that this court, in In re Estate of Brooks (1965), 32 Ill.2d 361, 205 N.E.2d 435, held that an adult Jehovah's Witness had a first amendment right to refuse blood transfusions. The appellate court then extended the holding in Brooks to include "mature minors," deriving this extension from cases in which the United States Supreme Court allowed "mature minors" to consent to abortions without parental approval through the exercise of constitutional privacy rights. (See City of Akron v. Akron Center for Reproductive Health, Inc. (1983), 462 U.S. 416, 103 S.Ct. 2481, 76 L.Ed.2d 687; Bellotti v. Baird (1979), 443 U.S. 622, 99 S.Ct. 3035, 61 L.Ed.2d 797.) Although the United States Supreme Court has not broadened this constitutional right of minors beyond abortion cases, the appellate court found such an extension "inevitable." Relying on our Emancipation of Mature Minors Act (Ill.Rev.Stat.1987, ch. 40, par. 2201 et seq.), the court held that a mature minor may exercise a constitutional right to refuse medical treatment.

The appellate court noted that E.G., at the time of trial, was only six months shy of her eighteenth birthday, and that the trial court believed E.G. to be a mature individual. Based on these facts, the appellate court declared that E.G. was partially emancipated and therefore had the right to refuse transfusions. The court, however, affirmed the finding of neglect against Denton, E.G.'s mother.

We granted the State's petition for leave to appeal under our Rule 315 (107 Ill.2d R. 315). This case presents several issues for our consideration: (1) whether this appeal should be dismissed as moot, since E.G. turned 18 on November 25, 1987, and is no longer a minor; (2) whether a minor has a right to refuse medical treatment and if so, how this right may be exercised; and (3) whether the trial court's finding of neglect against Denton should stand.

Both parties agree that although this case is technically moot, it should not be dismissed. Normally, this court will not adjudicate an appeal where a live controversy no longer exists. (People ex rel. Black v. Dukes (1983), 96 Ill.2d 273, 276, 70 Ill.Dec. 509, 449 N.E.2d 856; Madison Park Bank v. Zagel (1982), 91 Ill.2d 231, 234-35, 62 Ill.Dec. 950, 437 N.E.2d 638.) Here, since E.G. has reached her eighteenth birthday, she can no longer be adjudged a neglected minor for the purpose of the Juvenile Court Act of 1987. (See Ill.Rev.Stat.1987, ch. 37, par. 802-3.) We do not review cases merely to guide future litigation or establish precedent. (Madison Park Bank, 91 Ill.2d at 235, 62 Ill.Dec. 950, 437 N.E.2d 638.) Where no present controversy exists between the parties, a case should be dismissed as moot. 91 Ill.2d at 235, 62 Ill.Dec. 950, 437 N.E.2d 638.

Nevertheless, there are exceptions to the mootness doctrine. One departure from the usual rule occurs when a case presents an issue of substantial public interest. (In re Estate of Brooks (1965), 32 Ill.2d 361, 364-65, 205 N.E.2d 435; People ex rel. Wallace v. Labrenz (1952), 411 Ill. 618, 622-23, 104 N.E.2d 769.) In determining whether a case exhibits the requisite degree of public interest, we look to "the public or private nature of the question presented, the desirability of an authoritative determination for the future guidance of public officers, and the likelihood of future recurrence of the question." (411 Ill. at 622, 104 N.E.2d 769.) We note that both Labrenz and Brooks involved Jehovah's Witness members who refused to consent to blood transfusions. In Labrenz and Brooks, this court concluded that significant public interest existed and, although the controversies were moot, decided the cases on the merits. Similarly, we find that the case before us meets the public interest...