RIGHT TO REFUSE OVERRIDDEN, THEN UPHELD FOR YOUNG, COMPETENT
NONTERMINAL PATIENT
In Bouvia vs. County of Riverside (Calif., 1983), the court was faced with what to do
about a young, non-terminal competent patient who wished to refuse food and
hydration. The patient, a 26-year-old woman, had suffered from cerebral palsy from
birth. Although severely disabled, she was not terminal. Ms. Bouvia was in a great dea
of physical pain and increasingly unhappy with the dehumanizing aspects of having a
permanent tube through her nose and into her stomach. Convinced that her life was
hopeless, she sought to starve herself to death while hospitalized. When the hospital
attempted to force-feed her, she went to court in an attempt to obtain an injunction that
would stop the forced feeding, arguing that her constitutional right to privacy permitted
her to starve herself to death.
The court disagreed. It held that while the patient might have the right to end her life,
she did not have the right to do so with the help of the hospital staff. Thus, Ms. Bouvia'
right to privacy was outweighed by society's interest in preserving her life and in
protecting against the adverse effect her decision would have upon the professional
integrity of those caring for her and upon other patients in the hospital.
However, in 1986, the California Court of Appeals overturned the original decision in a
unanimous vote. They concluded that not "all and every life must be preserved against
the will of the sufferer."19 The court added "the right to refuse medical treatment" was
"basic and fundamental."20
Upon winning her case, however, Bouvia decided not to have the feeding tube
removed. Susan M. Wolf, J.D., an associate for law at the Hastings Center, a medical
ethics think tank in Briarcliff Manor, N.Y., says that the Bouvia case is a "prime example
of the paradoxical nature of competent, non-terminal patients and the right-to-die. It is
proper that the courts stand ready to vindicate the right. Whether a person chooses to
exercise it is a quite separate right." 21
2-13. PRESERVING THE SANCTITY OF ALL LIFE: PUBLIC SAFETY AND
WELFARE
a. Ethical Responsibility. The state has an interest in protecting the public
safety and welfare. The public safety is an exception to what is normally done for the
patient in terms of protecting a patient's autonomy, confidentiality, and privacy. There is
an ethical responsibility imposed upon physicians to protect and promote the public
safety, which, at times, may compromise the welfare of the individual patients. In such
situations, when there is a genuine risk to specific persons or to the public at large, the
physician must take measures to protect the public safety at the expense of the patient's
interests. The quarantining of carriers of infection, mandatory immunizations, and the
reporting of infectious diseases to the health department are public safety measures
required by law, in most jurisdictions. These measures are designed to warn, for
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