Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42 Page 43 Page 44 Page 45 Page 46 Page 47 Page 48 Page 49 Page 50 Page 51 Page 52 Page 53 Page 54 Page 55 Page 56 Page 57 Page 58 Page 59 Page 60 Page 61 Page 6233 32 Freedom from Pain There is nothing more distressing to parents than watching their children suffer. It was particularly agonizing, then, for “Nadia” and “Rafi”—immigrants from Afghanistan—to watch their daughter, “Abiba,” writhe and grimace in pain while the help she needed remained out of reach. Abiba was in her mid-30s when Legal Aid of San Diego referred her case to Mintz Levin. Gradually, as she grew into adulthood, she had begun to experience excessive bleeding and extreme pain during her monthly cycle. Diagnosed at birth with a severe intellectual disability, Abiba wasn’t able to say what was bothering her or how much it hurt. However, to Nadia and Rafi, her primary caregivers, Abiba’s movements and facial expressions made her agony clear. Years earlier, when Abiba began to experience problems, her doctor recommended a hysterectomy. To expedite that remedy, her parents obtained a limited conservatorship. That legal arrangement, approved by a judge, enables a responsible party or parties to assist an adult with developmental disabilities who is unable to provide for his or her own personal or financial needs. Given the nature of the surgery Abiba required, however, her parents found they needed more than a limited conservatorship to authorize her medical procedure. The law provides addi- tional protections when a medical intervention will result in sterilization, and a hysterectomy, while relieving Abiba’s pain, would also make it impossible for her to ever bear children. The extra protection is designed to ensure that life-changing decisions made on behalf of vulnerable individuals are in their best interests, and—to the extent that a court can deter- mine—reflect their desires. “The provision protects individuals, and rightly so,” said attorney Antony Nash, who led the team that worked on Abiba’s case. Antony collaborated with attorney Anne-Marie Dao and assistant Diane Johnson to find a path forward. Together they identified a unique combination of legal statutes that clarified what could be done in a case like Abiba’s. The key, they learned, is to establish that the medical procedure is for the individual’s well-being and not primarily for the purpose of ster- ilization. The case law also suggested that it’s important to prove that alternative treatments wouldn’t be adequate. The procedure must be a last resort. The team also had to provide assurance to Abiba’s court-appointed attorney that this was in her best interest. Concerned that Abiba might want to have children down the line, the attorney wanted to discuss her capabilities, state of mind, and level of pain. The team also arranged for the attorney to meet with Abiba’s doctor, who discussed her condition and provided a written statement for the court. “Thank you very much for thinking about our daughter and us. We really appreciate your kindness.” “Nadia” and “Rafi” Pro Bono Clients continued