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Maryland’s High Court Affirms Right of Prisoner to Refuse Medical Treatment like Any Other Competent, Fully Informed Adult

On October 26, 2009, the Public Justice Center led a coalition including the Maryland Disability Law Center, the American Civil Liberties Union of Maryland, the D.C. Prisoners’ Rights Project of the Washington Lawyers’ Committee for Civil Rights and Urban Affairs, and On Our Own of Maryland, Inc., in filing an amicus brief in the Maryland Court of Appeals in the Stouffer v. Reid, No. 54, Sept. Term 2009.  In Stouffer, the circuit court had upheld the right of Mr. Troy Reid, an inmate with the Maryland Department of Corrections, to refuse dialysis that had been recommended to treat end-stage renal disease.  The lower court found that Mr. Reid was competent, non-suicidal, and fully informed of the likely benefits of dialysis for his condition.  Thus, according to the circuit court, without any evidence that the treatment was necessary to address an immediate threat to prison safety, Mr. Reid retained the right of any competent adult to refuse medical treatment.  After unsuccessfully appealing the circuit court decision to the Court of Special Appeals, the Department of Corrections sought and obtained review before the Court of Appeals.  The Department justified its attempt to force treatment upon Mr. Reid on the theory that if it allowed Mr. Reid to refuse, other inmates might believe that the Department had denied Mr. Reid treatment or might themselves threaten refusal in an attempt to obtain special privileges.

In a brief authored by former Francis D. Murnaghan, Jr. Appellate Advocacy Fellow C. Matthew Hill and co-authored by former Maryland Deputy Attorney General Carmen M. Sheppard, Amici urged affirmance of the Court of Special Appeals’ decision.  Amici argued that the Department’s “evidence” of a threat to prison security from Mr. Reid’s refusal of dialysis was mere speculation.  This kind of conjecture is insufficient to override a competent adult’s deeply rooted, common law and constitutional right to refuse medical treatment.  The ethical canons of influential medical societies, such as the American Medical Association, confer an unqualified duty on medical professionals to accept the informed judgment of competent patients regarding a course of treatment.  Little changes in the correctional setting.  According to the nation’s leading correctional healthcare organization, the National Commission on Correctional Health Care, any breach of a competent inmate’s right to refuse medical treatment must be temporary and justified only by an immediate, grave threat to institutional safety.  Amici warned that allowing the Department to force a particular treatment on Mr. Reid upon the flimsy speculation that a false rumor may circulate would turn the presumption in favor of an adult’s right to refuse treatment on its head—allowing the Department to force treatment in almost any circumstance where it disagreed with the inmate’s choice and placing Maryland’s correctional healthcare professionals in a difficult ethical dilemma. 

On April 22, 2010, the Court of Appeals unanimously affirmed the decision of the Court of Special Appeals, agreeing that the Department could not infringe upon Mr. Reid’s right to refuse medical treatment under the circumstances presented by the case.  The Court explained that the Department’s “non-specific claim of preservation of life, safety, and security was insufficient to demonstrate that Reid’s refusal of medical treatment would cause a disruption or impact safety in the institution, or endanger the ethics of the medical profession.”  This decision ensures that the right of a competent adult to make fundamental decisions about his or her medical care retains meaning even within a prison’s walls.

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