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Elizabeth Bouvia

Who is Elizabeth Bouvia?

  • Crucial figure in the right-to-die movement
  • Born in 1958 with cerebral palsy and degenerative arthritis
  • She is a quadriplegic and suffered severe pain from her arthritis
  • She could not support herself financially and relied solely on public assistance for all of her medical care

- On September 3, 1983 Elizabeth Bouvia admitted herself into California’s Riverside General Hospital expressing she wanted medical professionals to keep her comfortable while she starved herself

- When hospital workers refused, she reached out to media outlets and attorneys to help her case

- She was denied by the courts to have assistance in starving herself and the hospital was given permission to force-feed her through a feeding tube.

Nicole Scala, Leroy Williams, Michelle Chan, Lindsay Nolan, Nosa Otagho

Is it Legal?

  • The right to refuse medical treatment stems from the common-law of informed consent
  • This includes life-saving treatmen
  • Doctors and the court system is not allowed to intervene in personal decisions especially if the person is deemed competent (she was cleared that she is in fact competent)
  • If a patient has been given full disclosure about treatment and side effects, they retain right to reject treatment

Virtues of Medicine

  • Longevity - A core value of medicine that pushes for maximizing the lifespan of the patient

  • Quality of life - The practice of establishing the highest quality of life possible for the patient under their diagnostic circumstances, with quality of life being primarily determined by patient comfort

  • Paternalism - the policy or practice on the part of people in positions of authority of restricting the freedom and responsibilities of those subordinate to them in the subordinates' supposed best interest.
  • What type of paternalism was practiced by the physicians in regard to the case?

What Happened in the End?

  • The appeals court reversed the trial court's verdict which held that Ms Bouvia had the right to have the nasogastric tube removed because:
  • (1) she had a fundamental right to refuse medical treatment;
  • (2) her rights superseded the state's interests;
  • (3) quality of life was a valid and essential consideration;
  • (4) fulfilling the patient's desire to refuse treatment was not equivalent to assisting the patient in committing suicide.

The Case

  • A competent adult, even if not terminally ill, may deny force-feeding even if it has life-threatening consequences.
  • A rejection of medical treatment is the decision of the patient’s alone and no one has the right to intervene
  • A case like this would no longer bring controversy in modern day

Implications of the Case

Bryan A. Liang, MD, PhD, JD,

and Laura Lin, MBA

Societal Perspective

Elizabeth's Side

  • Deciding who has this right and who does not
  • Is this fair for people who have or have family members with cerebral palsy?
  • It is against some people's religious and moral beliefs
  • The "slippery slope arguement"
  • "Over 65% Americans believe that if a person has a disease that is incurable, a patient can decide if they want to end their life by some painless means"
  • She refused medical treatment
  • Her quality of life has been diminished to the point of hopelessness, uselessness, unenjoyability, and frustration
  • Her caregivers believed that the state's interests in preserving life compelled their decision to insert a nasogastric tube against her will
  • Unable to take her own life without the involvement of other people

-She sought a court order that would prevent the medical staff from force-feeding her, and give medical treatment that does not go beyond maintenance care of relief of pain

-48 declarations were filed by hospital staff, all stating that they have strong moral, ethical and religious objections to carrying out Mrs. Bouvia’s wishes while she is a patient at the hospital

Thought Question

Who do you think is missing from this conversation?

Ethics and Morals

Many in the field felt that there were only two options: Comply with her request of assisted suicide or forcibly “treat” her

  • What type of issue is this?
  • Does this track of thinking show evidence of the six step process?

Medicine is a practice that hinges on consent

  • Respect for autonomy - the patient has the right to refuse or choose their treatment
  • Beneficence - a practitioner should maximize the “good” of the patient
  • Non-maleficence - do no harm

Which of these moral values seem to be at odds with one another with regard to the case?

SKIT

Thank You!

Sources

Annas, G. J. (1984). Law and the Life Sciences: When Suicide Prevention Becomes Brutality:

The Case of Elizabeth Bouvia. Hastings Center Report, 20-46. doi: 10.2307/3561879

Benatar, D. (2011). A legal right to die: responding to slippery slope and abuse arguments.

Current Oncology, 18(5), 206.

Cassell, E. J. (1984). Life as a work of art. Hastings Center Report, 35-37. doi:10.2307/3561096

Cummings, J. (1983, December 13). Judge prepares to rule on death plea. The New York

Times. Retrieved from http://www.nytimes.com/.

Fischer, L. (1987). The suicide trap: Bouvia v. Supreme court and the right to refuse medical

treatment. Loyola of Los Angeles Law Review, 21, 219-253. doi: 10.1176/3987

Kane, F. I. (1985). Keeping Elizabeth Bouvia alive for the public good. Hastings Center

Report, 15(6), 5-8. doi: 10.2307/3563061

Liang, B. & Lin, L. (2005). Bouvia v. Superior Court: Quality of Life Matters. Virtual Mentor, 7,

2-6. doi:10.1145-356/78

O’Dell, R. M. (2011). The Bouvia case revisited: an introduction to the bioethical topics of

individual rights, acts of conscience, and the right to die. Online Journal of Health Ethics, 7, 1-10. doi: 10.18785/ojhe.0702.05

Simpson, O. (2011). Consent and assessment of capacity to decide or refuse treatment. British

Journal of Nursing, 20(8), 510-513.

Steinbrook, R. (1986). The case of Elizabeth Bouvia. Starvation, suicide, or problem patient?

Archives of Internal Medicine, 146(1), 161-164. doi:10.1001/archinte.1986.00360130199026

Van den Haag, E. (1984). A right to die? National Review, 36(8), 45-46. Retrieved from

http://content.ebscohost.com

  • After the ruling, the feeding tube was removed and Ms Bouvia was eventually discharged from the facility.
  • In the following months, she continued to lose weight and suffer increasing discomfort from arthritis and other ailments.
  • She then entered a private hospital, agreeing not to attempt starvation.
  • Elizabeth Bouvia is alive today and stated in an interview with 60 Minutes that she "has had pleasure in living"

Class Discussion

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