Bartling v. Superior Court

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Bartling v. Superior Court is the title of a US court case from the state of California that determined a patient's self-determination to reject life-support measures.

Medical background

The 70-year-old American William Francis Bartling used to work in dental sales and was a smoker . Six years earlier, his health had deteriorated steadily. He suffered from an abdominal aortic aneurysm , arteriosclerosis , heart disease and severe chronic emphysema . Because of these illnesses, Bartling has been hospitalized six times in the past twelve months. On April 8, 1984, Bartling was admitted to the Glendale Adventist Medical Center in Glendale, California for severe back pain. A routine x-ray found abnormalities in the x-ray of his lungs . A lung biopsy confirmed the suspicion: In addition to his four serious diseases, there was also an inoperable bronchial carcinoma . During the biopsy, his lungs ( pneumothorax ) collapsed . Bartling was then put on a ventilator in the hospital's intensive care unit to help him breathe. Because he was bedridden , Bartling's muscles deteriorated. Attempts to let him breathe freely without a ventilator failed. At that point it was clear that there would be no future for him without a ventilator and the appropriate tubes in his body. The treating physicians made a prognosis for artificial ventilation that Bartling would die of one of his diseases within a few weeks to a few months, without a ventilator within a few minutes. Bartling's treatment cost over half a million US dollars from April to October 1984.

The legal case

Both Bartling and his three years younger wife Ruth expressed their will to staff at Glendale Adventist Medical Center that the device should be removed from the fourth week after his admission . The couple knew that removing the ventilator would mean the death of William Bartling. Bartling himself was - due to the ventilator - not able to speak, but through his actions - he repeatedly removed the ventilation tube independently - he expressed his will. The attending physicians and the nursing staff contradicted the Bartlings' request and temporarily tied his hands to the long sides of his hospital bed so that he could no longer remove the ventilation tube. William Bartling then wrote a statement in which he expressed that he did not want the life support measures. He and his wife issued a health care proxy ( durable power of attorney in healthcare ). With written declarations, the couple undertook not to assert any liability claims against the doctors and the hospital if they complied with their requests for the ventilator to be removed. The attending physician then showed a fundamental understanding of Williams' request, but a legal advisor advised the hospital management to continue artificial ventilation. On the one hand, the staff appealed to the doctor's claim to save lives, which they would be violating, and on the other, they feared criminal and civil claims, since the patient was not in acute danger of death. The handcuffing of Bartling's hands to his bed is to prevent a " suicide ".

The clinic management tried unsuccessfully to move Bartling to another hospital that would comply with his request. Bartling's wife and her lawyer then took legal action. The lawyer demanded that the hospital obey his client's request. He also filed a criminal complaint against the doctors and the Glendale Adventist Medical Center for treating Bartling without his consent and for violating Bartling's constitutional rights. As compensation, he asked for $ 15,000 per day in damages that his client was connected to the ventilator for longer. In total, the lawsuit against the Seventh-day Adventist hospital was $ 10 million.

One day before the trial, in June 1984, his lawyer recorded the legal deposition and video of Bartling in the hospital. He asked Bartling three questions. When asked “whether he would like to live”, Bartling gave an affirmative sign with his nod. The question of whether he “would like to continue living with the ventilator” he negated. In response to the last question as to whether he was aware that he would die if the ventilator was removed or artificial ventilation was suspended, he gave a positive sign.

Trial Court Decision

The Trial Court (first court instance) rejected Bartling's lawsuit. It only saw the right to remove life-support devices in the case of comatose and terminally ill patients. Bartling's condition was classified by the deciding judge as lethal ( terminal ), but not as directly life-threatening ( imminent ). The trial court also rejected a subsequent request from Bartling's lawyer that his client's hands should be untied so that he could end the artificial ventilation himself .

The case subsequently garnered considerable national attention when Mike Wallace showed a documentary of Bartling's fate on his 60 Minutes program . Bartling's attorney challenged the trial court's decision . The case was decided by the superior superior court .

Decision of the Superior Court

The Superior Court ( California appellate court ) ruled in December 1984 that Bartling had a right to refuse treatment. His right to privacy , which both the United States Constitution (see 4th Amendment to the United States Constitution ) and California law grant him, should be valued higher than the state's interest in protecting his life and the ethical claims of the medical profession . This right is not limited to comatose or terminally ill patients. The clinic management argued that preserving life was a key task for a Christian life-affirming institution like the Glendale Adventist Medical Center . The court contradicted this with the statement that "the patient's right to self-determination of his or her health care must come first in the interests of the hospital and its doctors". The Superior Court also ruled that neither the clinic staff nor the clinic itself can be prosecuted under criminal or civil law if it corresponds to the wishes of a sane adult patient. In such cases, no court approval is required to implement the patient's request. In addition, the Superior Court made a clear distinction between refusing a medical measure and suicide. If a sane adult patient refuses medical treatment and then dies, this is not a suicide, since the death of the patient has a natural cause and is not caused by an act - which the patient himself initiated.

William Bartling died on November 6, 1984 - tied to his bed and on artificial respiration - during the appeal hearing, of acute kidney failure.

further reading

Individual evidence

  1. ↑ Original judgment : Bartling v Superior Court. , 163 Cal App 3d 186 (1984).
  2. ^ JB Eisenberg and JC Kelso: Legal implications of the Wendland case for end-of-life decision making. In: West J Med. 176, 2002, pp. 124-127. PMID 11897738 PMC 1071696 (free full text)
  3. ↑ a b c d e f A. H. Malcolm: Right to Die dispute focuses on Californian. In: New York Times, October 21, 1984.
  4. ↑ a b c d e f g h R. J. Devettere: Practical Decision Making in Health Care Ethics: Cases and Concepts. Georgetown University Press, 2009, ISBN 978-1-58901-251-6 , pp. 158-162. limited preview in Google Book search
  5. ↑ a b c J. F. Drane: Clinical Bioethics. Rowman & Littlefield, 1994, ISBN 1-55612-612-3 , p. 108. Limited preview in Google Book Search
  6. ^ E. Deutsch and A. Spickhoff: Medical Law. Verlag Springer, ISBN 3-540-72467-2 , p. 442. Restricted preview in the Google book search
  7. ↑ Original quote: if the right of the patient to self-determination as to his own medical care is to have any meaning at all, it must be paramount to the interest of the patient's hospital and doctors. The right of a competent adult patient to refuse medical treatment is a constitutionally guaranteed right which must not be abridged.
  8. ↑ AH Malcolm: Plaintiff is dead, but suit goes on. In: New York Times, November 8, 1984

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