## Facts

- Martha Duarte suffered catastrophic head and neck injuries in a car accident and was admitted comatose to a hospital emergency department, placed on a respirator.
- A consulting neurologist reviewed diagnostic studies and told the family Duarte could not regain cognitive function; he later opined she was in a persistent vegetative state and had no chance of recovery.
- Family members stated Duarte had previously expressed that she would not want to be kept alive by machines and would want to be allowed to die in such circumstances.
- The family requested removal of the respirator; nursing staff and the neurologist were informed of the request.
- The attending physician sought consent for procedures facilitating long-term care placement; the family refused and renewed the request to withdraw the respirator.
- The attending physician stated he would not authorize withdrawal of the respirator unless Duarte was brain dead or the family obtained a court order.
- Before any court order issued, Duarte was determined to be brain dead, and life support was discontinued.
- The family sued the hospital and attending physician, seeking damages for emotional distress and related theories based on the refusal to withdraw life support or transfer her to a provider who would do so.

## Issues

1. Whether a physician and hospital incur tort liability for refusing to withdraw life-sustaining treatment or transfer a patient when family members request withdrawal based on the patient’s prior oral statements and no written directive exists.
2. Whether statutory immunity and liability-limiting provisions protecting health care providers apply despite the absence of a formal written advance directive.
3. Whether the trial court erred by refusing a proposed jury instruction that would have imposed a negligence duty to assess recovery prospects and follow the patient’s wishes as expressed by surrogate decision-makers.

## Decision

- The Court of Appeal affirmed the judgment for the hospital and physician.
- The court held plaintiffs failed to establish legally actionable wrongdoing from the refusal to withdraw life support or transfer the patient under the circumstances.
- The court upheld the trial court’s finding that defendants’ conduct was not “outrageous,” defeating the intentional infliction of emotional distress theory.
- The court found no instructional error in rejecting plaintiffs’ proposed instruction because it would have created duties beyond the governing statutory scheme and existing law.

## Legal Principles

- Health care providers acting in good faith within California’s end-of-life statutory framework may receive substantial protection from tort liability in disputed treatment-withdrawal situations.
- Refusing to withdraw life-sustaining treatment absent brain death or a court order, where no written directive exists, does not by itself constitute “outrageous” conduct required for intentional infliction of emotional distress.
- Courts will not impose, through jury instructions, broad common-law duties compelling withdrawal of life support based solely on family testimony about a patient’s prior oral statements, particularly where the Legislature has addressed the subject through detailed statutes.
- In the absence of a clearly established duty requiring immediate compliance with family requests, a cautious provider approach (seeking objective legal or medical confirmation before withdrawal) may fall within acceptable professional judgment and avoid negligence liability.

## Conclusion

The Court of Appeal affirmed a defense judgment, concluding that a hospital and attending physician were not liable for declining to withdraw life support or transfer a patient based on family reports of oral wishes when no written directive existed, and that insisting on brain death or a court order did not support negligence or intentional infliction of emotional distress on these facts.


Duarte v. Chino Cmty. Hosp., 72 Cal. App. 4th 849, 85 Cal. Rptr. 2d 521 (Ct. App. 1999)