Bouvia v. Superior Court

179 Cal. App 3d 1127 (1986)

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Nature of the Case

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Facts

P is a 28-year-old woman. She has severe cerebral palsy. She is quadriplegic. She is now a patient at a public hospital maintained by the County of Los Angeles. P is completely bedridden. Except for a few fingers of one hand and some slight head and facial movements, she is immobile. She is physically helpless and wholly unable to care for herself. She cannot stand or sit upright in bed or a wheelchair. She lies flat in bed and must do so for the rest of her life. She suffers from degenerative and severely crippling arthritis. She is in continual pain. Another tube permanently attached to her chest automatically injects her with periodic doses of morphine which relieves some, but not all of her physical pain and discomfort. P is intelligent, very mentally competent. She earned a college degree. She was married but her husband has left her. She suffered a miscarriage. She lived with her parents until her father told her that they could no longer care for her. She has stayed intermittently with friends and at public facilities. She is without financial means to support herself and, therefore, must accept public assistance for medical and other care. P has expressed the desire to die. She had attempted to starve herself to death on prior occasions. A court denied her judicial assistance to accomplish that goal. P is not consuming a sufficient amount of nutrients. She stops eating when she feels she cannot orally swallow more, without nausea and vomiting. She is fed soft liquid-like food. The medical staff inserted a feeding tube against her will and contrary to her express written instructions. P petitioned to have the tube removed. The physicians and administrators at the hospital and the State (Ds) argued that their interest in preserving P’s life outweighed her desire to refuse life-saving treatment. Ds argued that the state's interests in (1) preserving life, (2) preventing suicide, (3) protecting innocent third parties, and (4) maintaining the ethical standards of the medical profession, including the right of physicians to effectively render necessary and appropriate medical service and to refuse treatment to an uncooperative and disruptive patient. Ds argued that P is a patient in a public facility, thereby making the state a party to the result of her conduct, (2) she is not comatose, nor incurably, nor terminally ill, nor in a vegetative state, all conditions which have justified the termination of life-support system in other instances, (3) she has asked for medical treatment, therefore, she cannot accept a part of it while cutting off the part that would be effective, and (4) she is, in truth, trying to starve herself to death and the state will not be a party to a suicide. The trial court agreed with Ds and found P’s weight loss to be a life-threatening condition. The court found that P might live another 15 to 20 years. It refused the injunction. P filed this writ.