July 19, 2013 – Although the case was “bristling with important social policy issues,” the Wisconsin Supreme Court did not decide whether minors can refuse potentially life-saving medical treatment on religious grounds because the case at hand is moot.

Some states recognize the so-called “mature minor doctrine,” which allows minors to make medical treatment decisions if they demonstrate a sufficient understanding of the nature of the decision and consequences involved. Wisconsin has not considered it.

In this case, a 15-year-old girl with aplastic anemia, a life-threatening disease affecting bone marrow and production of blood cells, refused a blood transfusion on religious grounds. A doctor told the teen that she would die without a blood transfusion.

Her parents supported the decision, as members of the family are Jehovah’s Witnesses and believe God prohibits transfusions. However, the parents did not refuse on her behalf. They said their daughter was mature enough to decide on her own.

The girl had testified in court that a blood transfusion is stigmatized in her religion and would be devastating mentally and physically and tantamount to rape.

A circuit court judge, on Dane County’s petition, appointed a temporary guardian to determine whether to consent, in the minor’s place, despite her religious objections.

The guardian consented, and the girl received numerous blood transfusions. But the guardianship expired while the case was pending at the appeals court stage.

In oral arguments, Dane County counsel noted that the minor had not since been subjected to any blood transfusions that would prompt another court-ordered guardian.

Thus, an appeals court dismissed the case as moot, and the supreme court upheld that decision in Dane County v. Sheila W., 2013 WI 63 (July 10, 2013). The minor had asked the supreme court to make a determination on the merits despite the mootness issue.

In a per curiam opinion, supported by four justices, the court decided that mootness required it to refrain from deciding the case, despite the important issues it raises.

“This case undoubtedly presents issues of great public importance,” the court noted. “In this instance, we deem it unwise to decide such substantial social policy issues with far-ranging implications based on a singular fact situation in a case that is moot.”

Justice David Prosser wrote a concurring opinion to further explain why court action is “premature and undesirable at this time” while explaining the mature minor doctrine.

“A number of states have adopted some form of the doctrine, but there is little consistency about how to determine when a minor is ‘mature’ and the full extent of the decisions to which that ‘maturity’ may apply,” Justice Prosser wrote.

He said several states have passed legislation on the issue – including Arkansas, New Mexico, South Carolina, and Virginia, and various courts have adopted it. In Tennessee, for instance, the courts have adopted different rebuttable presumptions based on age.

But the legislation and the court decisions are inconsistent, and Wisconsin Legislature is the best place for the mature minor doctrine to be considered, Prosser suggested.

“Asking this court to enshrine Sheila’s view into our law is asking the court to make profoundly important policy determinations about the rights of minors as well as the role of parents and the role of the state without statutory guidance,” he wrote.

Justice Prosser added: “[P]ermitting a minor to refuse lifesaving medical treatment comes uncomfortably close to permitting a minor to commit suicide.”

Justice Prosser also noted a recently decided case involving parents who used prayer instead of medicine to treat their sick child and the child died. The Supreme Court recently upheld the parents’ convictions for second-degree reckless homicide.

“Against that backdrop, what is the parental duty here?” asked Justice Prosser, noting the question was not briefed and suggesting the court would ne unprepared to address it. “[D]oes a state’s adoption of a mature minor doctrine relieve parents of whatever duty they have to provide medical care to their ‘mature’ children?”

Dissent

Justice Michael Gableman wrote a dissenting opinion, joined by Justices Patience Roggensack and Annette Ziegler, concluding that the case should be decided despite the mootness issue because the matter is likely to recur but evades review.

“I fail to see why the facts in this case make it a bad candidate to evaluate whether Wisconsin should adopt the common law mature minor doctrine or decide the scope of a minor’s due-process rights,” Justice Gableman wrote.

Justice Gableman a decision should be rendered because a decision “will literally have life or death consequences” and circuit courts don’t have a standard to decide the issue.

“Unfortunately, four members of this court refuse to offer any guidance to circuit court judges who must actually adjudicate these difficult situations,” Justice Gableman wrote.

Justice Gableman also wondered why the case was accepted in the first place: “If the court did not want to decide the issues presented in this case, it should not have granted the petition for review, ordered briefing, and then held oral argument.”