A court ruling in Massachusetts has implications for everyone diagnosed with schizophrenia and other mental illnesses, wherever we live.  The whole problem with "Mary Moe" being legally required to obtain an abortion would have been avoided if this woman had in place a psychiatric advance directive, or mental healthcare proxy, that stated what her wishes would be if she were unable to speak for herself.

Unfortunately, as the Boston Globe story announced in a bold caption: "Disabled patients' wishes ignored."  The family court ruled that "Mary Moe" should undergo an abortion and be sterilized.  She was pregnant and psychotic and didn't think she was pregnant.  She refused obstetric testing and care. 

As a devout Catholic, she told court officials she would never have an abortion.  She is 32 years old and has a son. 

Her parents, who have custody of her son, stated that terminating the pregnancy is in "Mary's" best interest.  In Massachusetts, courts have the final say in these kinds of cases.  The original ruling was later overturned.  In the first resolution, Norfolk judge Christina Harms cited "substantial delusional beliefs" in claiming "Mary" was not competent to make a decision about the abortion.  Her reasoning was that if the woman were competent, she would choose to end the pregnancy. 

In Massachusetts, this line of reasoning is titled "substituted judgment" and is required under Massachusetts law in guardianship cases involving "extraordinary treatment" such as abortion and administering antipsychotic medication.  This rule applies to people who are legally deemed incapacitated because of mental illness, and other reasons like developmental disabilities and dementia. 

Last Tuesday, the appeals court struck down the original ruling and remanded the case to family court. 

"Substituted judgment" became the norm in Massachusetts as the result of a landmark case in the late 1970s.  According to the Boston Globe article, the state Supreme Court "ruled that incompetent patients have the right to refuse treatment, and that the court must act as a surrogate to determine what the patient would choose." 

Like I said in the lead-in to this SharePost, if "Mary Moe" had in place a psychiatric advance directive or mental health care proxy before she became delusional, her wishes would have to be taken into consideration. 

In New York State, this kind of advance directive is a legal document that you fill out and get signed and notarized by a notary public with witnesses and the signature of your psychiatrist.  My mother is my mental healthcare proxy tasked with telling professionals in the field what treatments I would or would not consent to if I were unable to state my preferences myself. 

In no instance am I to be given Risperdal, Zyprexa or Clozaril.  My first choice of bringing me out of an agitated state is to use drugs, like a shot in the thigh, and my last choice is restraint.