## Facts

- Larry Bergstedt was a severely disabled adult, described as a ventilator-dependent quadriplegic, living in a long-term care setting.
- Bergstedt sought to discontinue mechanical ventilation, understanding that removal would foreseeably and quickly result in death from respiratory failure.
- Because Bergstedt could not physically disconnect the ventilator himself, he sought judicial authorization for medical providers to withdraw the ventilator without legal risk.
- The State, through a state official (McKay), opposed or urged heightened scrutiny, citing interests in preserving life, preventing suicide, protecting vulnerable persons, and maintaining medical ethics.
- The district court found Bergstedt competent to make medical decisions, found his wish clear and consistent, and authorized withdrawal of ventilation subject to conditions such as appropriate palliative measures.
- The State appealed the authorization order to the Nevada Supreme Court.

## Issues

1. Whether a competent adult has a constitutional and common-law right to refuse life-sustaining medical treatment, including mechanical ventilation, when refusal will lead to death.
2. Whether the State’s interests (preserving life, preventing suicide, protecting third parties, and preserving medical ethics) outweigh a competent patient’s refusal of treatment.
3. What procedural safeguards and evidentiary showings are required before a court may authorize withdrawal of life-sustaining treatment for a competent but physically dependent patient.
4. Whether withdrawal of life support in these circumstances constitutes unlawful assistance in suicide or impermissible euthanasia, including concerns about discriminatory devaluation of disabled persons’ lives.

## Decision

- The Nevada Supreme Court affirmed the district court’s order authorizing withdrawal of Bergstedt’s ventilator support.
- The court recognized a protected liberty interest, informed by constitutional autonomy/privacy concepts and common-law bodily integrity and informed consent, to refuse unwanted medical treatment.
- The court held that honoring a competent patient’s informed refusal of life-sustaining treatment is legally distinct from assisted suicide or euthanasia.
- On the record presented, the State’s asserted interests did not justify overriding Bergstedt’s competent, voluntary, and informed decision.
- The court approved the use of judicial authorization to permit clinicians to withdraw treatment and to provide legal protection when acting pursuant to the order, conditioned on careful findings and humane care.

## Legal Principles

- A competent adult may refuse any medical treatment, including life-sustaining interventions, even when refusal will result in death.
- The right to refuse treatment rests on bodily integrity and informed consent principles and is protected as a liberty interest in medical decision-making.
- Withdrawal of unwanted life-sustaining treatment is not treated as suicide or assisted suicide; death is attributed to the underlying medical condition once artificial support is removed.
- Courts must balance the patient’s autonomy against state interests, commonly including preservation of life, prevention of suicide, protection of third parties, and ethical integrity of the medical profession.
- Judicial authorization may be appropriate when a competent patient cannot physically implement the refusal, provided the court makes explicit findings of competence, voluntariness, and informed decision-making and imposes appropriate safeguards (including palliative care).

## Conclusion

The Nevada Supreme Court held that a competent, ventilator-dependent adult could refuse continued ventilation and that a court may authorize clinicians to withdraw life-sustaining treatment after confirming the patient’s informed and voluntary decision and determining that the State’s countervailing interests do not outweigh the patient’s right to bodily autonomy.


McKay v. Bergstedt, 801 P.2d 617 (Nev. 1990)