The Case of Elizabeth Bouvia
html
keyboard_arrow_up
School
City College of Angeles *
*We aren’t endorsed by this school
Course
1022
Subject
Law
Date
Nov 24, 2024
Type
html
Pages
3
Uploaded by DoctorKudu1046
M
ODULE
4: R
EQUIRED
R
EADING
•
1
•
2
•
3
•
4
•
5
P
RELIMINARY
R
EMARKS
In 1983, Elizabeth Bouvia decided that she wanted to die. Bouvia was 25 at the time of
her initial request to end her life by starvation. Bouvia claimed that being utterly
dependent upon someone for meeting all her personal needs was “humiliating.” In her
words, “It's disgusting, and I choose to no longer do that, no longer to be dependent
on someone to take care of me in that manner ... I am choosing this course of action
due to my physical limitation and disability" (Annas 20-21, 46).
The hospital she was at refused to allow her to die, and instead, resorted to force-
feeding her through a tube. Bouvia took her case to court. The courts initially ruled against Bouvia, cited that allowing her to starve would have a devastating impact on the hospital staff as well as members of the community of disabled persons. As a result, Bouvia was intubated and force-fed against her will.
F
ACTUAL
B
ACKGROUND
Bouvia eventually took the case back to court and the decision was overturned in her favor. Below are the facts of the case as stated in Bouvia v. Superior Court
:
Petitioner is a 28-year-old woman. Since birth she has been afflicted with and suffered from severe cerebral palsy. She is quadriplegic. She is now a patient at a public hospital maintained by one of the real parties in interest, the County of Los Angeles. Other parties are physicians, nurses and the [179 Cal. App. 3d 1136]
medical and support staff employed by the County of Los Angeles. Petitioner's physical handicaps of palsy and quadriplegia have progressed to the point where she 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 is totally dependent upon others for all of her needs. These include feeding, washing, cleaning, toileting, turning, and helping her with elimination and other bodily functions. She cannot stand or sit upright in bed or in a wheelchair. She lies flat in bed and must do so the rest of her life. She suffers also 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.
She 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. A search for a permanent place to live where she might receive the constant care which she needs has been unsuccessful. She is without financial means to support herself and, therefore, must accept public assistance for medical and other care.
She has on several occasions expressed the desire to die. In 1983 she sought the right
to be cared for in a public hospital in Riverside County while she intentionally "starved herself to death." A court in that county denied her judicial assistance to accomplish that goal. She later abandoned an appeal from that ruling. Thereafter, friends took her
to several different facilities, both public and private, arriving finally at her present location. Efforts by the staff of real party in interest County of Los Angeles and its social workers to find her an apartment of her own with publicly paid live-in help or regular visiting nurses to care for her, or some other suitable facility, have proved fruitless.
Petitioner must be spoon fed in order to eat. Her present medical and dietary staff have determined that she is not consuming a sufficient amount of nutrients. Petitioner
stops eating when she feels she cannot orally swallow more, without nausea and vomiting. As she cannot now retain solids, she is fed soft liquid-like food. Because of her previously announced resolve to starve herself, the medical staff feared her weight loss might reach a life-threatening level. Her weight since admission to real parties' facility seems to hover between 65 and 70 pounds. Accordingly, they inserted the subject tube against her will and contrary to her express written instructions. fn. 2 [179 Cal. App. 3d
1137]
Petitioner's counsel argue that her weight loss was not such as to be life threatening and therefore the tube is unnecessary. However, the trial court found to the contrary as a matter of fact, a finding which we must accept. Nonetheless, the point is immaterial, for, as we will explain, a patient has the right to refuse any medical treatment or medical service, even when such treatment is labelled "furnishing nourishment and hydration." This right exists even if its exercise creates a "life threatening condition."
F
URTHER
C
ONSIDERATIONS
Bouvia’s Family Life:
Bouvia’s family life was difficult. She did not have much support from her family, and in fact, was abandoned by her mother at a young age. In 1982 Elizabeth married ex-
convict Richard Bouvia. They tried to conceive a child. She suffered a miscarriage. Richard eventually left her, claiming that he “could not accept her disabilities, a miscarriage and rejection by her parents.” However, when the trial became a public debate, he hitchhiked from Iowa to Riverside, CA, retained a lawyer and filed to become her legal guardian, accusing the ACLU of using Elizabeth as a “guinea pig.” (Steinbock and Lo 61).
F
URTHER
C
ONSIDERATIONS
After the Ruling:
After the appellate court ruled in her favor, Bouvia decided not to die. In 1994 Bouvia lived in a private hospital room with 24 hour care. The cost was $300 a day for her care paid for by Medical. She was given morphine for her pain and described her life as
“a lot of needles and bags.” She did not like being more “physically comfortable than before” but not “happy.” She watched television and noted that “There is nothing really to do. I just kind of lay here.” (Pence, 2015, p. 24)
In 1997, with the assistance of a new pro bono attorney, Bouvia was moved to her own
apartment with 24-hour in-home care, which cost the state less than supporting her care in the hospital. She was still alive in 2013. All reports from Bouvia have suggested
ambivalence about her life.
Below are two perspectives on Bouvia’s case. Please consider them in formulating your
response to the prompt.
“One Life to Live.” America, vol. 149, no. 22, 1983, p. 422.
Van Den Haag, Ernest. “The Right to Die?” The National Review, 4 May 4, 1984, pp. 45-46.
W
ORKS
C
ITED
Annas, George. "When Suicide Prevention Becomes Brutality: The Case of Elizabeth Bouvia." The Hastings Center Report
, vol. 12, no. 2, 1984, pp. 20-21, 46.
Bouvia v. Superior Court (Glenchur). Court of Appeals of California, Second Appellate District. 1986. https://law.justia.com/cases/california/court-of-appeal/3d/179/1127.html
Steinbock, Robert, and Bernard Lo. "The Case of Elizabeth Bouvia: Starvation, Suicide, or Problem Patient." Archives of Internal Medicine
, vol. 146, no. 1, 1986, 61.
Pence, Gregory. Medical Ethics: Accounts of Ground-Breaking Cases 7
th
Edition
. New York: McGraw Hill, 2015.
•
1
•
2
•
3
•
4
•
5
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help