## Facts

- Lee Ann Grady, a 19-year-old woman with severe intellectual disability (Down syndrome), lived with and was cared for by her parents.
- She attended special-education programs but had significant cognitive and communication limitations and lacked understanding of sexual relations, contraception, and childbearing.
- As she neared age 20, her parents planned to place her in a work-training and residential program for persons with intellectual disabilities.
- After consulting her physician, her parents sought a tubal ligation as a precaution before the change in living environment; the hospital declined without court authorization.
- The trial court appointed a guardian ad litem, interviewed Lee Ann, heard testimony from her father and expert witnesses, and authorized sterilization based on a substituted-consent rationale.
- The New Jersey Public Advocate appealed, challenging the authority and standards for court-approved sterilization of an incompetent adult.

## Issues

1. Whether a court may authorize sterilization of an incompetent adult by appointing a guardian to make the decision on the individual’s behalf, given the constitutional significance and irreversibility of sterilization.
2. Whether a court of equity has inherent authority to act in the absence of specific legislative direction, and what substantive and procedural standards must govern any authorization.

## Decision

- The Supreme Court of New Jersey held that a court of equity has inherent power to authorize sterilization of an incompetent person by protecting and effectuating the incompetent person’s own constitutional procreative choice.
- The Court rejected broad parental authority as an independent basis to consent to sterilization and required that any authorization be grounded in the individual’s rights and welfare.
- The Court announced stringent substantive and procedural safeguards for future cases.
- The Court concluded the trial-level record and process were not sufficiently rigorous under the newly articulated standards and required further proceedings consistent with those standards.

## Legal Principles

- A severely mentally impaired person retains fundamental privacy and procreative rights; incompetence does not extinguish constitutional protections.
- A court of equity may act absent statutory guidance to protect an incompetent person’s fundamental rights, but only with close judicial scrutiny because sterilization is irreversible.
- Authorization requires clear and convincing evidence that the individual lacks capacity to make an informed reproductive decision.
- The court must evaluate medical and practical considerations, including pregnancy risks, procedural risks, and the availability and feasibility of less intrusive contraceptive alternatives.
- Decision-making must focus on the individual’s likely wishes if ascertainable and, at minimum, the individual’s best interests rather than parental convenience or state population-control interests.
- Robust procedures are required, including independent representation (such as a guardian ad litem) and a full adversarial hearing with competent expert testimony to develop a complete factual record.

## Conclusion

The court recognized judicial authority to authorize sterilization for an incompetent adult only as a means of protecting the individual’s own constitutional procreative rights, and it required strict evidentiary showings and procedural protections before any irreversible sterilization may be approved.


In re Grady, 426 A.2d 467 (N.J. 1981)