Kaimowitz v. Michigan DMH (1973)

42 U.S.L.W. 2063

Civil No. 73-1934-AW

Nature of Case

Whether involuntarily committed psychiatric patients can voluntarily consent to psychosurgery.

Facts of Case

On January 11, 1955, the Kalamazoo County Circuit Court committed John Doe to Ionia State Hospital in Michigan, as a sexual psychopath, without a trial. At the time of his commitment, he was 18 years old and his commitment followed the charges of rape and murder of a student nurse. He was never offered a hearing, was never offered psychotherapy as a form of treatment, and he was labeled “treatment resistant.”

In 1972, at 36 years old, he was asked to participate in a state-funded experimental study, which aimed to determine the efficacy of two treatment methods for reducing aggression. One method was a medication, cyproterone acetate (antiandrogen), which was expected to result in impotence and reduce aggression. The other method was a psychosurgical procedure called an amygdalotomy, which was also expected to reduce aggression. Doe and his parents gave consent for Doe to participate in the study. His consent was reviewed by a committee of three neurologists and a human rights review committee, which consisted of a law and psychiatry professor, a clergyman, and a community representative. His consent was considered valid and he was the only consenting subject involved in the study. The consent form discussed that the patients may receive psychosurgery and described potential risks; however, the consent form did not mention the right to withdraw from the study.

Gabe Kaimowitz, a Michigan Legal Services attorney, unrelated to the Doe case, learned of the experiment and informed the media. Kaimowitz filed a petition that Doe and others were being held for experimental surgery. Doe was appointed independent counsel and a habeas corpus petition was submitted on his behalf asserting that he was being illegally detained because the Michigan criminal sexual psychopath statute was unconstitutional. The statute had previously been repealed; however, those already committed under the statute were retained in custody. On March 23, 1973, Doe was granted his freedom, because the court held the statute could not withstand the challenge of the equal protection clause. Following his notification of release, Doe retracted his consent. He did not commit any additional acts of violence, earned a job, and became engaged; however, the state of Michigan then pursued criminal prosecution against him for the 19-year-old charges of rape and murder. Even without Doe, the Circuit Court for Wayne County, Michigan decided to pursue the hearing of the case concerning the ability to voluntarily consent to psychosurgery, as it applied to all current and future involuntary patients.

Issue

Can involuntarily hospitalized psychiatric patients voluntarily consent to psychosurgery?

 

Holding

The Circuit Court for Wayne County, Michigan ruled that involuntarily detained mental patients could not give informed consent for psychosurgery. The court decided that basic elements of informed consent could not be obtained reliably due to their involuntary status. The court indicated that involuntarily committed patients were incapable of giving competent, voluntary, and knowledgeable consent to experimental psychosurgical operations. The court also asserted that 1st Amendment rights to speech and expression could be destroyed or impaired by psychosurgery, and the constitutional right to privacy could be infringed upon by the psychosurgical intrusion into an individual’s brain.

Rationale

The court cited provisions of the Nuremberg Code and indicated voluntary consent was absolutely essential for psychosurgery. The court indicated that the consent of involuntarily committed patients for psychosurgery generally would not meet the requirements because their consent was not 1) competent, 2) voluntary, and 3) knowledgeable. The court defined competency as “the ability of the subject to understand rationally the nature of the procedure, its risks, and other relevant information.” The court argued the legal capacity to consent was diminished by the nature of incarceration, which made the individual more vulnerable to coercion. The court asserted that “involuntarily confined mental patients live in an inherently coercive institutional environment” and “are not able to voluntarily give informed consent because of the inherent inequality in their position.” The court concluded that any attempt at obtaining voluntary consent for psychosurgery would be invalid. Valid consent requires the knowledge of the risks and ill effects that may come from participation. The court stated that since much was still unknown concerning the brain and brain surgery, that the “lack of knowledge on the subject makes a knowledgeable consent to psychosurgery literally impossible.” Therefore, the court made an absolute ban on psychosurgery for involuntarily committed psychiatric patients.