## Facts

- Nancy Milton was hospitalized for mental illness as a voluntary psychiatric patient; no court had adjudicated her legally incompetent.
- Milton was diagnosed with uterine cancer, and physicians recommended medical treatment that was potentially life-extending (including surgery and other modalities).
- Milton refused the recommended cancer treatment because of sincerely held religious beliefs favoring faith healing.
- A probate petition sought to have Milton declared incompetent and to appoint a guardian to consent to cancer treatment over Milton’s objection.
- The probate court granted guardianship and authorized treatment, relying in part on Milton’s faith-healing beliefs as evidence of incapacity.
- The court of appeals affirmed.

## Issues

1. Whether a person’s psychiatric hospitalization or diagnosis permits an inference of legal incompetence to make medical decisions about potentially life-extending treatment.
2. Whether the state may compel a legally competent adult to undergo medical treatment that conflicts with the person’s sincerely held religious beliefs.
3. Whether courts may treat the substance of a person’s faith-healing beliefs as evidence of incapacity to provide informed consent.

## Decision

- The Supreme Court of Ohio reversed.
- The court held Milton had not been shown legally incompetent to decide whether to accept cancer treatment.
- The court held the state may not compel a legally competent adult to submit to medical treatment that violates sincerely held religious beliefs, even if the treatment is arguably life-extending.
- The court ruled the lower courts erred by using the content of Milton’s religious beliefs as evidence of incapacity.
- The guardianship order used to authorize treatment over Milton’s objection was overturned.

## Legal Principles

- The First Amendment and the Ohio Constitution protect an individual’s freedom to choose and practice religious beliefs.
- A legally competent adult has a protected liberty interest in refusing medical treatment.
- The state may not compel medical treatment that violates a competent adult’s sincerely held religious beliefs, even when the treatment may extend life.
- Mental illness or psychiatric commitment and legal incompetency are distinct; mental illness does not create a presumption of incompetence.
- Capacity must be assessed based on decision-making ability, not on whether a choice or belief is unconventional.

## Conclusion

The Ohio Supreme Court held that, absent a valid finding of incompetence, the state could not use guardianship proceedings to override a competent adult’s refusal of potentially life-extending cancer treatment grounded in sincerely held religious beliefs, and it rejected treating faith-healing beliefs as proof of incapacity.


In re Milton, 505 N.E.2d 255 (Ohio 1987)