Question

Case study

On April 5, 1984, William Bartling was admitted to the Glendale Adventist Medical Center in Los Angeles. He was seventy years old and suffered from five ordinarily fatal diseases: emphysema, diffuse arteriosclerosis, coronary arteriosclerosis, an abdominal aneurysm, and inoperable lung cancer. During the performance of a biopsy to diagnose the lung cancer, Mr. Bartling's left lung collapsed. He was placed in the ICU, and a chest tube and mechanical respirator were used to assist his breathing.

Mr. Bartling complained about the pain the respirator caused him, and he repeatedly asked to have it removed. When his physician refused, he pulled out the chest tube himself. This happened so often that eventually Mr. Bartling's hands were tied to the bed to keep him from doing it. He had signed a living will in an attempt to avoid just such a situation.

Although after discussions with Richard Scott (Mr. Bartling's attorney), Mr. Bartling's physician and the hospital administration agreed to disconnect the respirator, the hospital's attorney refused to permit it. He argued that, since Mr. Bartling was not terminally ill, brain dead, or in a persistent vegetative state, the hospital might be open to legal action.

Mr. Scott took the case to Los Angeles Superior Court. He argued that Mr. Bartling was legally com­ petent to make a decision about his welfare and that, although he did not want to die, he understood that disconnecting the respirator might lead to his death. The hospital's attorney took the position that Mr. Bartling was ambivalent on the question of his death. His statements "I don't want to die" and "I don't want to live on the respirator" were taken as inconsistent and so as evidence of ambivalence. Removing the respirator, the attorney argued, would be tantamount to aiding suicide or even committing homicide.

The court refused either to allow the respirator to be removed or to order that Mr. Bartling's hands be freed. To do so, the court ruled, would be to take a positive step to end treatment, and the only precedents for doing so were in cases in which the patients were comatose, brain dead, or in a chronic vegetative state.

The case was then taken to the California Court of Appeal, which ruled as follows: "If the right of a patient to self-determination as to his own medical treatment is to have any meaning at all, it must be paramount to the interests of the patient's hospitals and doctors. The right of a competent adult patient to refuse medical treatment is a constitutionally guaranteed right which must not be abridged."

The ruling came too late for Mr. Bartling. He died twenty-three hours before the court heard his appeal.

Question:

1) Do you agree with the hospital's position that removing Mr. Bartling's respirator or freeing his hands would be equivalent to assisting suicide.

2) On what grounds might Bartling request be honored?

Answer 1

1. Do you agree with the hospital's position that removing Mr. Bartling's respirator or freeing his hands would be equivalent to assisting suicide?

No, I do not agree with the given instance because of the following reasons-

• While refusing treatment Mr. Bartling does not have any intent to die and is not making any irrational decision or demands which can cause self-destruction.
• Mr. Bartling is competent enough to make a rational decision and the particular demand made by him does not require any sort of assistance from doctors or any external aid.
• Removal of respirator does not amount to self-affliction of deadly harm. This may lead to Mr. Bartling’s death but that is something inevitable as he is suffering from so many chronic diseases.
• Doing so may lead to death by natural causes. Respirator is an artificial means to extend his life and that too by making him feel uncomfortable and life more painful.

·        Removing of respirator will hasten the rate of his death by natural causes and not by any other medical aid like death inducing chemicals.

Therefore, removal of respirator or feeing Mr. Bartling’s hands with his knowledge and consent does not tantamount to assisting suicide.

2. On what grounds might Bartling request be honored?

On following grounds, Bartling request can be honored-

• Mr. Bartling is competent because he is an adult enough and is of sound mind. His case is of not like that of patients demanding euthanasia who are in a vegetative state and are unable to make decisions about their own welfare.
• Bing a competent adult Mr. Bartling enjoys a constitutionally guaranteed right to control the decisions of his own medical care which includes refusing medical treatment. This right must not be abridged.
• Mr. Bartling does not wish to die but wants to live a life with lesser pain. Decision made by him does not put anyone in question as the given case does not make a bio-ethical issue.