Removing Life Support Might be an Intervening Cause to Murder, but not a Defense

State v. Abella (HSC December 17, 2019)
Background. Michael Abella was indicted for murder in the second degree. At trial the prosecution presented evidence that on a night in July 2014, at the corner of Smith and Pauahi Streets in Chinatown Abella stood over Shelton Higa and was violently kicking and punching him. A group of people intervened and stopped him. Abella left the area. The police soon intervened. Higa was conscious and filled out some paperwork. The police testified that they could smell the odor of alcohol on Higa’s breath. The medics also arrived and checked him out. He appeared stable and refused a ride in the ambulance to the hospital. About an hour later the ambulance returned to the scene. Higa was rolling around on the ground screaming and yelling. He was transported to Queen’s, where he was combative, agitated, and had “significantly high” blood pressure. He fell unconscious and remained in a coma. Treating physicians testified and concluded that Higa had suffered from a large subdural hematoma, which puts pressure on the brain and cuts off blood flow to the brain. The doctors performed brain surgery and saw a large blood clot inside his skull.

Twelve days after falling into a coma with his chances of survival slim, the doctors concluded that he would not be the same even if he did live. Higa’s next of kin, after consultations with the physician, decided to remove life support and he died. At trial, the circuit court provided this instruction over Abella’s objection: “Conduct is the cause of a result when it is an antecedent but for which the result in question would not have occurred.” The Hon. Judge Colette Garibaldi presided. Defense counsel did not request an instruction on causation pursuant to HRS §§ 702-215 and 702-216. Abella was found guilty of manslaughter. The circuit court sentenced him to twenty years imprisonment. He appealed. The ICA—Chief Judge Lisa Ginoza, Judge Alexa Fujise, and Judge Lawrence Reifurth—affirmed.


HSC Abandons Plain Language of Uniform Health-Care Decisions Act and Precludes Defendant who Caused Injuries from Relying on it as Defense. “Death resulting from the withholding or withdrawal of health care in accordance with this chapter shall not for any purpose constitute a suicide or homicide.” HRS § 327E-13(b). The provision is part of the Uniform Health-Care Decisions Act. HRS Chapter 327E. Abella argued that the plain language of this statute absolves him of any criminal liability. The person who actually made the decision to end life support was not him, but Higa’s daughter. He relied on the plain language that states death resulting from the withdrawal of health care “shall not for any purpose” constitute a homicide—even this one. The HSC disagreed.
The HSC examined cases from other jurisdictions that have interpreted similar statutes. It also tracked the legislative history of the act which started in 1986 and its subsequent amendments. The HSC concluded that when death arises from removal of life support, the legislature intended to ensure that the people properly involved in making and carrying out this decision to terminate should be free from criminal and civil liability. See In re: Farrell, 529 A.2d 404, 415-416 (N. J. 1987); In re Quinlan, 355 A.2d 647, 669 (N. J. 1976). The statute cannot be read out of context and must be read only to protect those who conduct was “in accordance with” HRS Chapter 327E. That would include those with the power of attorney for health care to make a health-care decision, guardians, or health care providers. HRS § 327E-2.

HSC will Ditch Plain Language when Clearly Out of Step with Legislative Intent. In arriving at this holding, the HSC made it plain that the statutory language must read “in the context of the entire statute” and interreted “in a manner consistent with its purpose.” State v. Haugen, 104 Hawaii 71, 75, 85 P.3d 178, 182 (2004). A statute must be construed “to avoid, if possible, inconsistency, contradiction, and illogicality.” Id. When literal constructions produce absurd results, the court presumes that that result was not intended and construes the statute in accord with its underlying legislative intent. Id. at 77, 85 P.3d at 184.

The Trial Court Erred in Failing to Adequately Instruct the Jury on Causation. The HSC, however, found error in the jury instructions. Causation is an essential part of the criminal offense that links the defendant’s conduct with the result of that conduct. Generally “[c]onduct is the cause of a result when it is an antecedent but for which the result in question would not have occurred.” HRS § 702-214. That was the instruction provided here.

The HSC, however, noted that that was inadequate. While causation generally calls for no more than the “but for” test, issues arise in how far to cast the net. The difficulty with causation lies “in setting the appropriate standard for determining those instances in which the defendant will not be held liable for the result of the defendant’s conduct because the defendant did not intend or contemplate the result or was unaware of the risk that it would obtain.” HRS § 702-214 cmt.

That’s where HRS §§ 702-215 and 216 come into play. Intervening factors—such as the conduct of another—may change the causation analysis. These statutes present a different standard, the culpability standard, and is based on a bevy of factors. They apply when the actual result is “contrasted with the designed or contemplated . . . result in terms of its specific character and manner of occurrence.” State v. Martin, 573 A.2d 1359, 1364 (N. J. 1990).
Getting Beyond Actual Causation . . . The HSC outlined the statutory situations in which intervening causes must be considered: (1) when “a different person or different property is injured or affected” or the injury or harm is more or less serious than contemplated; (2) when the result is “too remote or accidental in its occurrence” or the occurrence is “too dependent on another’s volitional conduct.”). HRS § 702-215.

In this case there were no such instructions fashioned. The HSC held that this was precisely the kind of case that needed them. There appeared to be intervening facts that affected the result—in this case Higa’s death.

Where’s the Instruction? The HSC held that the circuit court erred in failing to provide an instruction on these statutes. At this point, there are no standard instructions about this issue. It looks like industrious lawyers will be contributing to the discussion by submitting something the next time around.

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