Reference no: EM132264936
Elizabeth Bouvia was diagnosed as having cerebral palsy at the age of six months. At age 10 she was placed in an orthopedic hospital, where she remained until age 17.
She later earned a B.S. degree in social work, married, and for a year at- tempted unsuccessfully to have a child. Her husband, whom she had met as a pen pal while he was serving a sentence in jail, has left her. Elizabeth drops out of graduate school because of difficulties in finding a clinical placement required for her program. As a result of this, the state threatens to take away her assistance for transportation.
At this time, Elizabeth Bouvia admits herself voluntarily to the hospital on the grounds that she is suicidal, a quadriplegic victim of cerebral palsy, and confined to a wheelchair. She has limited control of her right hand and needs to be fed. She also has severe progressive arthritis that causes constant pain. Her condition is in no way life-threatening, and she has a life expectancy of 15 to 20 years.
She seems to have plans to starve herself to death in the hospital, away from friends and relatives. She refuses to eat solid food. The physician threatens to have her certified as mentally ill so that he can force- feed her. The hospital also threatens to put her out on the sidewalk. The hospital does seek to transfer her to another facility, but is unsuccessful. In the meantime, the hospital force-feeds Elizabeth. She repeatedly tears the nasogastric tubes from her nose. The tube is forcibly reinserted each time she removes it.
Elizabeth seeks legal assistance. The American Civil Liberties Union enters the case and applies for a court order restraining the hospital from discharging her or force-feeding her. Bouvia testifies that she is no longer willing to live, since she found it disgusting and humiliating to live so dependent a life. She wants to starve to death while nurses give her painkillers and keep her clean and comfortable. She has a metabolic condition that causes her blood to become excessively acidic without food. One internist treating her estimates that she could be dead within five days because of the condition.
The first court decided that Bouvia had a legal right to starve herself to death at home, but not to demand that a health care facility help her while she did this. Another court finally decided that she had a right to hospital care while starving herself to death. Many years later, Bouvia was still alive. This might justify the statements of a health care provider who said that Bouvia was only seeking attention and knew how to work the system.
Will any of the theories of suicide permit Bouvia to deliberately starve herself to death? Is Bouvia competent? Would the hospital be ethical in getting a guardian ad litem who could then consent to a feeding tube? Would it be ethical for health care providers to cooperate with someone who is not terminally ill and still has the minimum quality of life; that is, who is able to interact with others?