Bright Line Rules v. Facts And Circumstances: Further Thoughts On In Re: Cassandra C.

What was the real legal dispute in In re: Cassandra C.?  Yes, the specific question was whether a 17-year-old teenager could be forced against her will to undergo life-saving chemotherapy.  But, what was the real issue? 

I think the real debate was over the merits of bright line rules versus fact and circumstance-based judgments. The law in Connecticut, and pretty much the entire nation, is clear: adults are deemed competent to refuse life-saving medical treatment; minors are not. How does the law distinguish between adults and minors? Society, via its elected representatives, draws a bright dividing line, usually at age 18. Above that age, you’re an adult. Below that age, you’re a minor.

Cassandra C. and her mother did not like that bright line rule.  In its place, they wanted Connecticut to adopt a facts and circumstances-based approach–the so-called “mature minor” doctrine–to determining whether an individual is competent to refuse life-saving medical care. At a bare minimum, they wanted the Supreme Court to turn the bright line rule into a rebuttable presumption. They pointed to a number of circumstances in which minors are allowed to make important medical decisions, such as deciding to have an abortion.

The debate over the value of bright line rules versus fact and circumstance-based judgments is not new. Bright line rules have certain benefits and certain costs. On the one hand, they serve important values in a legal system, including certainty and predictability. They also promote efficiency and reduce the transaction costs associated with resolving disputes. On the other hand, bright line rules limit discretion and may, at times, produce what appear to be “unjust” outcomes. They can also seem arbitrary. Why is a person competent to refuse medical treatment when she is eighteen but not when she is 17 years, 11 months and 29 days old?

By contrast, facts and circumstances-based approaches to resolving legal disputes broaden discretion and may produce what appear to be more just and equitable outcomes under the circumstances of a particular case. But such approaches may also lead to arbitrary results. For example, two situations that appear identical may be resolved differently. Facts and circumstances-based approaches also increase the transaction costs of resolving disputes. Such an approach to the Cassandra C. competency question means that the parties must hire lawyers and expensive experts to opine on a teen’s mental maturity and competency, and a trial court must use scarce judicial resources to resolve the parties’ competency dispute.  And then there is the cost of the inevitable appeal. . . .

An element of arbitrariness is inherent in any bright line rule.  It is unavoidable.  That is the nature of a rule.  But that does not mean that bright line rules should go the way of the Dodo bird. In a society based on the rule of law, we want our leaders, both elected and appointed, to resolves disputes between specific parties–what we lawyers call “cases or controversies”–based on legal rules, not their personal judgments about the equities of a particular situation.

Consider a tax collection system based not on rules, but on the individual judgment of a tax collector who comes to your home and decides how much he thinks you should pay in taxes.  Yikes! Or consider a criminal justice system based not on specific crimes set forth in codified statutes, but on the whim of a prosecutor who thinks you engaged in conduct that was somehow “wrongful.” Double yikes!

So, back to In re: Cassandra C. Is a bright line rule distinguishing adults from minors preferable to a facts and circumstances-based approach to that issue? I think it is.  Did the legislature act rationally in establishing a bright line at age 18? Given the state of the medical evidence concerning the continued development of the human brain well into a person’s twenties, I think the answer is yes. Is that the perfect age at which to draw the line? Perhaps, perhaps not, but perfection is not the test. Could the legislature have drawn the line at a different age? Sure. But does the law–particularly the federal constitution–prohibit the legislature from the drawing the line where it did? No.

That last point–the absence of a constitutional prohibition against drawing the line dividing minors from adults at age 18–was the central weakness in the argument Cassandra’s attorneys presented to the Supreme Court. Absent a constitutional prohibition, all Cassandra’s attorneys could really do was ask the Supreme Court to create a judicial exception to a legislatively-created rule. Such a request, however, is better addressed to the folks in the General Assembly who created the rule in the first place.