A Right to Die?

RECENT COURT decisions and subsequent protests have focused the public's attention on ethical issues that seem to preclude easy solutions. In past years, one such thorny issue was the so called "right-to-life" movement. But recently, society has become equally divided over one's "right to die."

Last month, a California Superior Court judge decided that a 26-year-old cerebral palsy victim-Elizabeth Bouvia-may not starve herself to death under the auspices of the hospital where she is a patient "In conventional folklore, Elizabeth Bouvia might have been an inspirational figure," News-week wrote at the time True, she has led an incredibly difficult and heroic life. A quadriplegic, she lived on her own, earned a college degree, and got married (she and her husband have since separated). But now that she has decided she no longer wants to go on, experts who debate the issue are once again discovering the morass of ethical implications surrounding any individual's decision to involve an institution in a personal choice.

In marked contrast to the outcome of Bouvia's case, a New York Superior Court judge last week decided in favor of an 85-year-old man who wished to starve himself in a nursing home While the doctors have begun force-feeding Bouvia, the anonymous patient died Sunday. The New York judge's ruling, which mentioned the Bouvia case, was based on a number of differences between the two.

Citing the vast gulf between the patients' ages, he remarked that Bouvia had a far longer life expectancy, she had more to lose. This point may be questionable; another point seems out-rageous. Nothing that, despite his frailty, the elderly man still had full use of his arms, he decided that it was wrong to mandate that the nursing home staff force-feed him, because it would entail "physically restraining him for the rest of his life." Bouvia's case was different, he noted, because she is mostly paralyzed, and therefore cannot resist the doctors.

This is a serious distinction to draw. The judge in effect is saying that the right to self-determination only applies to those without physical disabilities. As one medical expert told Newsweek, "She's claiming the classical liberal right of self-determination, but tragically, she's not self-determined. "Such an observation could easily and unfairly be used to justify a limitation of the constitutional rights of the handicapped.

Other disparities in the two cases also offer potentially important distinctions. The man in New York was suffering from illnesses which, while not necessarily terminal, might further reduce the number of his remaining years. Also, the nursing home is a private institution which probably has subtly different obligations than that of Riverside General Hospital. Moreover, this man was evidently dependent upon the home for his care, while Bouvia voluntarily checked herself into Riverside last September, she did not want to continue her difficult life on her own after her separation.

Perhaps the greatest difference between the two patients' cases is what they were requesting from the respective institutions. While one wanted simply to be left alone, Bouvia was seeking active aid in her plan. Not only did she wish to starve, but she also requested that doctors administer painkillers while she did so.

AS MOST arguments about euthanasia have pointed out, there is a grave difference between "passive" and "active" euthanasia. In the one case, a doctor may simply choose not to revive a terminally-ill patient whose heart has stopped, "letting nature take its course." In the other, a doctor actually may administer a lethal drug to put an end to a patient's suffering.

What Bouvia is requesting is not a lethal injection, but it may be construed as equally wrong: because her doctors would be forced not only to witness, but also to hasten her suicide. And it is readily understandable that this would contradict many of the implications of the Hippocratic oatch on which their profession is based.

The hospital should not be forced to administer Bouvia painkillers. But one may also argue that neither should it be compelled to force-feed her. The prolonged and well-publicized case of Karen Ann Quinlan in 1975 determined that parents of a comatose girl could ask her doctors to remove the life-sustaining respirator that was keeping her nominally alive. As the judge in that case said, interest in preserving life "weakens and the individual's right to privacy grows as the degree of bodily invasion increases and the prognosis dims."

While Elizabeth Bouvia does not have a terminal illness, she is a quadriplegic and as such has decided that the no longer deems her life worth the pain and effort. Despite the criticism her stance has received from handicapped groups who deride her for implying "that the disabled nothing to live for," her decision remains a personal one.

Harvard Professor of Law Alan M. Dershowitz notes the "ambivalence of the courts" in cases such as these. He says of this issue, "It's too easy for the courts to make mistakes." Dershowitz says he believes that "hospitals should never not feed someone."

In the Bouvia case, the obvious question is: why doesn't Bouvia go home to starve herself, if she is so resolved to do so? Her lawyers claim that she does not have sufficient control of her limbs to kill herself, but it seems that it is equally feasible to starve oneself in one place as in another. The staff of Riverside has complained that she is merely seeking publicity, perhaps this is true.

The situation does, however, deserve close consideration, for there may be another patient, unlike Bouvia, who is dependent on the hospital's care and cannot simply check herself out. That patient may find herself in the same position, but totally powerless a situation that makes the phrase "self- determination" seem irrelevant.