The Patient’s Choice

The 2nd California District Court of Appeal has unanimously reaffirmed the right of the individual to make the decisions regarding personal medical treatment, including decisions regarding life-sustaining feeding. The decision is correct, and will facilitate the process of gaining broader acceptance of this principle.

There would have been more integrity and enhanced effect had the justices writing the opinion stayed with the essentials and not strayed into other issues that courts can rarely if ever adjudicate. But the case before the court, by its very nature, invited those weakening elaborations of judicial thought.

Elizabeth Bouvia, a quadriplegic suffering from cerebral palsy, has repeatedly turned to the courts to free herself from medical interventions from doctors determined to resist what they perceive as her intention to starve herself to death or otherwise end her life. That history makes more complex a judgment in this case.

This complexity led the appeal court into such controversial issues as choosing between the quality of life and longevity, the prolongation of suffering and acceleration of death. But the court was clear on the real issue--the right of a competent adult alone to make the critical decisions as to therapy, including life-sustaining therapy.

“It is not a medical decision for her physician to make,” the court wisely found. “Neither is it a legal question whose soundness is to be resolved by lawyers or judges. It is not a conditional right subject to approval by ethics committees or courts of law. It is a moral and philosophical decision that, being a competent adult, is hers alone.”

This decision is an appropriate successor to the Court of Appeal’s similar finding in 1984 in a case involving a terminally ill patient. In the present case Bouvia is not terminally ill, and her life--and also her suffering, it has been argued--can be prolonged with medical intervention for many years.

The new decision is consistent with the conclusions of the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research: “The voluntary choice of a competent and informed patient should determine whether or not life-sustaining therapy will be undertaken, just as such choices provide the basis for other decisions about medical treatment.”

Subsequently, an American Medical Assn. study and pioneer work by the Los Angeles County Medical and Bar Assns. have affirmed that food and water are to be included among the life-sustaining therapies under consideration.