In re Grady – Sterilization
In re Grady, 85 N.J. 235, 426 A.2d 467 (1981).
NATURE OF THE CASE: This was a dispute over the sterilization of a severely mentally impaired adult.
FACTS: Grady was a 19 year old mentally impaired woman with Down’s syndrome. She was unable to read and had only moderate success in writing her name. She had some ability to count low numbers but was frequently unable to speak in complete sentences. She plays games, watches television and takes short walks. She can fold laundry and dust, but she cannot select her own clothes but can dress herself. She is able to bathe herself but needs someone to make sure the water is the right temperature. She can open a can of soup but has difficulty controlling the burner temperature. She is often jovial and friendly and although some of her external features identify her as born with Down’s syndrome, she is not afflicted with physical ailments and her life expectancy is normal.
Grady has no significant understanding of sexual awareness or marriage. If she became pregnant she would be unable to make important decisions and would not be able to care for a baby alone. Grady has been on birth control pills for the last four years and Grady’s parents want to have her sterilized.
The trial judge appointed a guardian ad litem. A dispute arose over the standards the court should apply to authorize sterilization. The judge determined that he would allow the parents to exercise substituted consent for Grady to be sterilized under the doctrine of parens patriae. This involved a five part test: 1) the subject must be incapable of understanding the nature of sexual functions, reproduction, or sterilization; 2) this incapability is in all likelihood permanent; 3) the incompetent is presumably not infertile and not incapable of procreation; 4) procedural safeguards have been implemented including the appointment of a guardian ad litem and a court proceeding; and 5) the applicants have demonstrated a genuine good faith concern for the incompetent rather than their own convenience. This appeal resulted.
ISSUE: Must the court determine if it is in the best interests of an incompetent to undergo sterilization?
RULE OF LAW: Yes. The court must determine if it is in the best interests of an incompetent to undergo sterilization.
HOLDING AND DECISION: Sterilization of incompetents has been the subject of abuse in the past. This decision involves a variety of factors well suited to rational development in judicial proceedings and the court is best suited to evaluate these factors and to reach a fair decision of what is in the incompetent’s best interests.
A court should ensure the exercise of the incompetent’s right in a manner that reflects his or her best interests. The court agreed that the statutes do not apply to this situation and the statutes do not restrict the rights of the court as it has the inherent power of parens patriae to allow the court to make decisions regarding sterilization of incompetents. It was this same power that invoked the decision in the Quinlan case. The exercise of parens patriae is intended to compensate for an incompetent’s inability to exercise her own constitutional rights concerning contraception. If we invoked the standard of necessity as urged by the state, it would infringe upon this fundamental right. We therefore affirm the trial court’s holding that necessity for sterilization need not be shown. However, we are compelled to adopt a stricter standard that the trial court did in order to prevent abuse of this process.
It is ultimately the duty of the court and not the parents to determine the need for sterilization. Custody, care, and nurturing of the child first resides with the parents, however the reproductive right is a personal right to the individual and ultimately that decision belongs to the child. The court must therefore establish that sterilization is in the best interests of the incompetent person. We agree with the appointment of a guardian ad litem and allowing the full opportunity to make independent investigation and a full ability to present evidence at hearing and to represent his client zealously. The trial court must also have the power to appoint experts if needed. The trial judge if possible should meet with the subject to obtain his own impressions of competency. The trial judge must find that the individual lacks capacity to make a decision about sterilization and that the incapacity will not change in the foreseeable future.
There must be clear and convincing proof that sterilization is in the best interests. The court should consider the possibility of the person becoming pregnant, that the person will experience trauma or damage if she becomes pregnant and even such damage from the sterilization, the likelihood that she will engage in sex or be exposed to situations in which sex could be forced upon her, the inability of the person to understand contraception and reproduction, the feasibility of less drastic medical procedures that will alleviate the problem, the wisdom of waiting for imposing the process, the ability of the person to care for a child, the possibility of medical advancements and the good faith of those seeking the procedure.
DISPOSITION: Remanded for reconsideration under the stricter standards as specified in the opinion.