What Are the Limits of a Court's Power to Order Medical Treatment?

Eugene Volokh has an interesting post on the question of whether a court may order treatment on a woman on the basis of "delusional" religious beliefs.

“During a hearing conducted on March 1, 2011, the District Court determined that L.K. is not competent to make her own medical decisions and directed that she undergo a radical hysterectomy on March 3, 2011, against her desires. L.K. objects to the surgery on religious grounds, and expert testimony admitted at the hearing indicated that her religious objections are delusional.” So states an order of the Montana Supreme Court, in Office of State Public Defender on Behalf of L.K. v. Montana Fourth Judicial District Court; the Montana Supreme Court stayed the district court’s order, and ordered an expedited appeal.

So an expert testified that L.K.'s religious beliefs are delusional, but by whose standard?  One of the most commonly held religious beliefs, spanning almost the entire breadth of world religion is the belief in an afterlife or reincarnation or something similar, that is a belief that the soul will live beyond the corporal existence of the body.  We accept that religious tenant despite having almost no empirical proof of its existence.  One could argue that after millennia of a dearth of proof of an afterlife, that maintaining such a belief is delusional.

The trial court, presumably based on expert testimony as to the delusional nature of L.K., ordered her to undergo an hysterectomy, despite L.K.'s own testimony that she wants to have children, that her husband is agreeable AND that she might change her mind about undergoing the recommended procedure.  Since, informed consent is the hallmark of medical treatment, and this woman has, in an apparently rational basis, considered the advice, consulted with her husband and remains open to the notion that she might changer her mind and have the procedure, I am wondering how the trial court came to the conclusion to force her to undergo the procedure? From the portion quoted above, it does not say that L.K. is completely incompetent or otherwise insane, only that the religious beliefs underlying her objection are delusional.   How far can the courts go to require otherwise competent, religiously zealous, person to undergo medical treatment against their will?

This case has some serious implications beyond this single dispute. Is religious zeal now a "condition" by which someone can be determined to be legally incompetent to make their own medical decisions?  It seems to me that there is a case for arguing that the court has infringed upon someone's right to the free exercise of their religion.

What if we are talking about other medical treatments, other than a radical hysterectomy?  Could a court order a heart surgery?  Could a court order a kidney transplant?  What about other life-saving treatments that are not so radical?  Could a court order a morbidly obese person into treatment involving exercise and diet changes?  What if the person is objects on the grounds that "God made me fat and who am I to disagree with God?  It's his plan and I am but a part of that plan."  There might be no question that the person will likely die if they don't exercise and alter their diet, but I find it to be perfectly normal to believe that God's plan might include morbidly obese people.  That is not delusional or at least, I don't see how it is delusional.

Since we are talking, in L.K.'s case, about reproductive health, could a court order an abortion?  Could the court order an abortion even when doctors are certain that either the baby or the mother or both will die as a result of carrying the child to term?  What if the mother AND the father, both competent, agnostic or atheist adults believe that it is wrong to terminate a pregnancy and that view is not based on any religious doctrine?  What if those agnostics or atheists want to, in light of all the advice to the contrary, carry the child to term despite the risks?  How can a court order a procedure when a sane person has made an informed choice?  Where does the court draw the line as far as whose life is more important?

Is this not the opposite of the question of "death panels" wherein governmental bureaucracy might ration health care in cases where they deem it to be unlikely to succeed?  IN other words, are we going to have a health and legal system that can at once deny care in some cases and require and enforce care in others?  How is that freedom or liberty?

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