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Elizabeth Bouvia

Force Feeding and Hydration
by

Kathleen Bolsover, RN, BSN

on 8 March 2017

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Transcript of Elizabeth Bouvia

Elizabeth Bouvia
Born in 1958
Right to Die Figure
Cerebral Palsy, Quadriplegic and Severe Degenerative Arthritis
Starvation
Comfort measures: Pain medication and hygeine
Relief from a life lacking quality
Elizabeth's Wishes
Preserve Life
Elizabeth's conditions imposed many physical disabilities:
Immobile and bedridden
Unable to care for herself
Chronic pain
No form of financial income
Relying on Public Assistance
Forced to leave her parent's home when they could no longer care for her
Elizabeth's husband left her
Also graduated college, but unable to work
Circumstances:
"Letting go of all burdens. It is being able to be free of my physical disabilities and mental struggle to live."
"It's not that I don't have the will to live, but it is too much of a struggle to live within the system or to depend on someone in the system. In reality, my disability is going to keep me from doing the living I want to do."
Motive
Conclusion
Riverside's Actions
When Elizabeth's weight fell between 65 and 70 pounds, a nasogastric tube was inserted against Elizabeth's wishes and written instructions
Elizabeth Bouvia v. Riverside Hospital
The American Hospital Association (AHA) Policy and Statement of Patient's Choices of Treatment Options

Council on Ethical and Judicial Affairs of the American Medical Association's statement of "Withholding or Withdrawing Life Prolonging Medical Treatment"
Supported By
Argument: Suicide
All persons have the right to terminate their life
The hospital's refusal to assist was discrimination
Refusing life-sustaining treatment is not suicide, but accepting death
Elizabeth Bouvia v. Riverside Hospital
Supported Through Analogy
Riverside Hospital
Right to End Life???
My intent is to die..
I intend to starve myself to death...
Hospital Mission
Is Assisted Suicide Legal in the United States?
1983, Age 26, Riverside
General Hospital
1986, High Desert Hospital
Appellate Courts- Not State policy to preserve life
Trial Court, State should
Preserve Life

Arguments: Refusal of Unwanted Medical Treatment
Removal of the NG Tube
A competent patient right to refuse any medical treatment, even if it may save or prolong his or her life.
Assistance required to eat constitutes as a medical treatment and she has the right to refuse
Autonomy
A patient's healthcare wishes should be honored
Beneficence:
Binds the physician to provide care that promotes patient's well being, relief of suffering and preservation of life
Conflict
**State prevails over Patient's Right to refuse treatment
Prevent Suicide
Protect Innocent Third parties
Maintain Ethical Standards
Physician -Sustain Life/relieve suffering
Prevent Suicide
Autonomy
Beneficence
VS.
Which Ethical Value Prevails?
Can they both work together??
What effect do you feel this case had on those involved?

Forced Tube Feedings
Ethical Dilemma
Autonomy
Beneficence
Summary
Defendent's argument
How do you think Elizabeth's stance effects stereotypes of disabilities?
What are some social effects that can
come from this case?
Hippocratic Oath
The court did note that Bouvia had no dependents, which would
support a finding that innocent parties would not be injured by Bouvia's
decision to refuse treatment.
States duty to preserve life is most signifiant
Fisher, L. J. (1987, November 1). The suicide trap: Bouvia v. Superior Court and the right torefuse medical treatment. Loyola of Los Angeles Law Review, 21(1), 218-254.
Johnson, M. (1984). Right to life, fight to die: The Elizabeth Bouvia saga. Advocado Press. Retrived from: http://www.normemma.com/advocacy/artbouvia.htm
Liang, B., & Lin, L. (2005). Bouvia v. Superior Court: Quality of life matters. Virtual Mentor, 7(2). Retrieved from: http://virtualmentor.ama-assn.org/2005/02/hlaw1-0502.html
Stradly, B. (2010, September 7). Elizabeth Bouvia: v. Riverside Hospital: Suicide, Euthanasia, Murder: The line blurs. Golden Gate University Law Review, 15(2), 407-413.
Elizabeth Bouvia v. the Superior Court of Los Angeles County (225 Cal. Rptr. 297) 1986. Retrieved from: http://www.lawandbioethics.com/demo/Main/Media/Resources/Bouvia.htm
References
Ethical Dilemma
Right Not to Eat
Force Feeding
How could this case effect
the hospitals mission?
Values?
Lehigh Valley Hospital
To heal, comfort, and care.......
Class Verdict
Pro-Elizabeth
Pro-Hospital
Right not to Eat
Ethical Values
Elizabeth Bouvia today??
NG TUBE STAYS
NG TUBE REMOVED


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