Respect for Right to Die Evolves When a Doctor Becomes an Attorney

Richard Stanley Scott began his professional career as a physician, saving battered bodies in a hospital emergency room. Today, as an attorney, he helps people end their lives.

Scott’s efforts usually grab headlines. He represented quadriplegic Elizabeth Bouvia in her unsuccessful fight to starve to death. Another client, terminally ill William F. Bartling, wanted to be disconnected from life-support systems. Scott won that legal battle seven weeks after the patient died.

“I have no crusade to get people dead,” he said. “I’m on a crusade to get hospitals to respect a patient’s wish to be in charge.”

The 47-year-old father of two said the idea of patients controlling their destiny was not even considered when he attended medical school in the early 1960s.

“In the old days, it was the patient’s duty to have the disease and thereafter to follow the doctor’s orders,” Scott said in his sixth-floor office in Beverly Hills.

“The idea that patients had something to say about (treatment) has happened only in the last 15 to 20 years. It’s part of the whole consumer movement.”

As a physician, Scott never dealt with decisions about pulling the plug on a life-support machine--the position he advocated as an attorney for Bartling and his first right-to-die client, William J. Foster.

“I worked in emergency medicine,” he said. “The emergency room is the last place you want to make such decisions. Those decisions should be the result of some time and thought and deliberation.”

Scott also has not had to deal with such decisions on a personal level, involving someone close to him. “If it involved my daughter or something? I don’t know,” he said, shaking his head.

For himself, he has signed a living will asking that no extraordinary efforts be made to extend his life if there is no reasonable expectation of his recovery.

His switch from medicine to law did not result from some cataclysmic experience. The route was more roundabout.

“Medicine as a full-time profession never got its claws into me all the way,” Scott said. “I’d always been interested in questions of social policy.”

That interest led the Washington native from Oregon, where he attended college and medical school, to California to work in medical education through television. He spent three years with the UCLA-based Medical Television Network and later became involved with KCET, Channel 28, where he was the original producer of “The Advocates.”

Then he went to law school at UCLA, graduating in 1973.

His practice focuses on civil litigation, most of it involving doctors and hospitals. But the cases that seize the public’s attention are those about patients who want to die.

Scott said that he likes and admires Bouvia and that he disagreed with her plan to starve herself in Riverside General Hospital.

‘It Was Her Decision’

“I thought her decision was unwise, that she had a lot to offer other people,” Scott said of the 27-year-old cerebral palsy victim who also suffers from severe arthritis. “But I felt even more that it was her decision.”

Bouvia, vowing to leave her “useless body,” admitted herself to the hospital in September, 1983, then asked that the staff give her painkillers and hygienic care but no food while she wasted away. Officials began force-feeding her when her weight dropped below 87 pounds, and she lost several court battles before she left the hospital last April.

In mid-January, Bouvia was in “terrible” condition and still wanted to end her life when Scott visited her at an undisclosed location.

“Her arthritis and spasticity are so bad that she can’t sit up. She’s only in bed or on a stretcher,” he said.

Scott’s most recent right-to-die client, Bartling, 70, entered Glendale Adventist Medical Center last April with five potentially fatal illnesses. He was placed on a respirator shortly after admission and was still on it when he died Nov. 6. His court victory--an appellate decision allowing terminally ill patients to refuse medical life support--was won Dec. 27.

The first right-to-die action brought to court by Scott--who said he believes that his three cases in court outnumber those handled by any other attorney--involved William Foster in 1981.

Foster, 67, suffered from amyotrophic lateral sclerosis, commonly known as Lou Gehrig’s Disease, and was paralyzed and dependent on a respirator. He was hospitalized longer than a year before he died at Wadsworth Veterans Administration Hospital in West Los Angeles.

He had sued to have the life supports removed, and a federal judge ruled in his favor but allowed 15 days for an appeal. Before the 15 days ended, a cardiac arrest left Foster brain dead and the hospital removed the life supports. He died shortly afterward.

Scott doesn’t think his advocacy of the right to die or court decisions that he and other attorneys have won will prompt hospitals to pull the plug on patients more readily.

“Hospitals will be very slow to plant the idea (in relatives’ minds),” he said. “Hospitals are places that care for patients.”

But the country soon will have to address the allocation of scarce medical resources that may mean that one person won’t get the same all-out treatment as another, he said.

“As we get an older and older population, we are sometime going to have to address the cost, that not everyone can have their life prolonged to the last possible moment in an intensive care unit,” he said. “There will have to be rationing, so that people who need it can have the opportunity to have their life prolonged rather than their death prolonged.”

Colorado’s Gov. Richard Lamm created a furor when he said much the same thing last March 27 to a group of health lawyers in Denver.

Scott’s representation of Bouvia on a pro bono basis for the American Civil Liberties Union caused internal dissent, but Scott maintained that it was an appropriate case for the group.