## Facts

- Elizabeth Bouvia, a mentally competent 28-year-old woman with severe cerebral palsy and quadriplegia, was bedridden, dependent on others for basic care, and in continuous pain.
- While a patient at a county-operated public hospital, she experienced significant weight loss and was considered at risk of death without nutritional support.
- Hospital staff inserted a nasogastric tube to provide nutrition when she could not be spoon-fed without nausea and vomiting.
- The tube was placed without her consent and maintained to keep her alive through involuntary feeding.
- Physicians believed she could live 15–20 additional years with adequate nutrition.
- Bouvia sought removal of the tube and an order barring further nonconsensual feeding or similar procedures.

## Issues

1. Whether a mentally competent adult has a protected right to refuse life-sustaining medical treatment, including artificial nutrition by nasogastric tube, even if refusal will foreseeably result in death and the patient is not terminally ill.
2. Whether the state’s interests in preserving life, preventing suicide, protecting third parties, and protecting medical ethics justify overriding a competent patient’s refusal of such treatment.

## Decision

- The Court of Appeal granted extraordinary relief and directed issuance of a peremptory writ of mandate.
- It held that a competent adult has a basic right to decide whether to accept or refuse medical treatment, including artificial feeding.
- It rejected any requirement that the patient be terminally ill or near death to exercise the right to refuse life-sustaining treatment.
- It concluded the trial court erred by treating removal of the tube as aiding suicide and by giving controlling weight to the state’s interest in preserving life.
- It directed the trial court to order removal of the nasogastric tube and to bar further nonconsensual forced feeding or comparable procedures.

## Legal Principles

- A competent adult has a fundamental right to control medical decision-making affecting their own body, including refusal of treatment that would prolong life.
- Forced medical treatment, including ongoing artificial nutrition through invasive means, is a serious intrusion on bodily integrity and personal autonomy.
- The right to refuse treatment is not limited to terminal illness and is not negated by a long projected lifespan if treatment continues.
- A patient’s refusal of medical treatment is legally distinct from assisted suicide; honoring refusal generally requires stopping nonconsensual treatment rather than providing an affirmative means of self-destruction.
- State interests in preserving life, preventing suicide, protecting third parties, and maintaining medical ethics may be considered, but do not automatically override a competent patient’s informed refusal absent stronger countervailing facts.

## Conclusion

The court held that a competent adult may refuse involuntary artificial feeding and that, on these facts, the asserted state interests did not justify continued nonconsensual life-sustaining treatment, requiring removal of the nasogastric tube and prohibiting further forced feeding.


Bouvia v. Superior Court, 179 Cal. App. 3d 1127 (Ct. App. 1986)