2 essays at a minimum of 1000 wirds. both on a different topic exprssiong for or against something

Here first are the facts of our case, as recited by the California Appellate Court in Bouvia v. Superior Ct. of L. A. County, 179 Cal. App. 3d 1127 (1986). Study these facts about the patient Elizabeth Bouvia, the Petitioner in the case, appealing the decision of a lower trial court which had refused her request to order the hospital to desist using a nasogastric feeding tube to treat her life-threatening condition:

          “Petitioner is a 28-year-old woman. Since birth she has been afflicted with and suffered from severe cerebral palsy. She is quadriplegic. She is now a patient at a public hospital maintained by one of the real parties in interest, the County of Los Angeles. Other parties are physicians, nurses and the medical and support staff employed by the County of Los Angeles. Petitioner’s physical handicaps of palsy and quadriplegia have progressed to the point where she is completely bedridden. Except for a few fingers of one hand and some slight head and facial movements, she is immobile. She is physically helpless and wholly unable to care for herself. She is totally dependent upon others for all of her needs. These include feeding, washing, cleaning, toileting, turning, and helping her with elimination and other bodily functions. She cannot stand or sit upright in bed or in a wheelchair. She lies flat in bed and must do so the rest of her life. She suffers also from degenerative and severely crippling arthritis. She is in continual pain. Another tube permanently attached to her chest automatically injects her with periodic doses of morphine which relieves some, but not all of her physical pain and discomfort.
          “She is intelligent, very mentally competent. She earned a college degree. She was married but her husband has left her. She suffered a miscarriage. She lived with her parents until her father told her that they could no longer care for her. She has stayed intermittently with friends and at public facilities. A search for a permanent place to live where she might receive the constant care which she needs has been unsuccessful. She is without financial means to support herself and, therefore, must accept public assistance for medical and other care.
          “She has on several occasions expressed the desire to die. In 1983 she sought the right to be cared for in a public hospital in Riverside County while she intentionally “starved herself to death.” A court in that county denied her judicial assistance to accomplish that goal. She later abandoned an appeal from that ruling. Thereafter, friends took her to several different facilities, both public and private, arriving finally at her present location. Efforts by the staff of real party in interest County of Los Angeles and its social workers to find her an apartment of her own with publicly paid live-in help or regular visiting nurses to care for her, or some other suitable facility, have proved fruitless.
          “Petitioner must be spoon fed in order to eat. Her present medical and dietary staff have determined that she is not consuming a sufficient amount of nutrients. Petitioner stops eating when she feels she cannot orally swallow more, without nausea and vomiting. As she cannot now retain solids, she is fed soft liquid-like food. Because of her previously announced resolve to starve herself, the medical staff feared her weight loss might reach a life-threatening level. Her weight since admission to real parties’ facility seems to hover between 65 and 70 pounds. Accordingly, they inserted the subject tube against her will and contrary to her express written instructions. [fn. Her instructions were dictated to her lawyers, written by them and signed by her by means of making a feeble “x” on the paper with a pen in her mouth.]”

     Bouvia, by her attorneys, asserted a right to choose the means by which she should be treated by the hospital. Here following, as recited by the Appellate Court, were the Los Angeles County hospital’s arguments in favor of its own contravening right to restrict the patient’s asserted right in this instance [note that the following passage, from the middle of the appellate court’s opinion, is omitted from Lewis Vaughn’s abridged version, but you can find it at the bottom left of page 4 of my Adobe Reader unabridged version]:

          “. . . [The] county hospital, its physicians and administrators, urge that the interests of the state should prevail over the rights of Elizabeth Bouvia to refuse treatment. Advanced by real parties under this argument are the state’s interests in (1) preserving life, (2) preventing suicide, (3) protecting innocent third parties, and (4) maintaining the ethical standards of the medical profession, including the right of physicians to effectively render necessary and appropriate medical service and to refuse treatment to an uncooperative and disruptive patient. Included, whether as part of the above or as separate and additional arguments, are what real parties assert as distinctive facts not present in other cases, i.e., (1) petitioner is a patient in a public facility, thereby making the state a party to the result of her conduct, (2) she is not comatose, nor incurably, nor terminally ill, nor in a vegetative state, all conditions which have justified the termination of life-support system in other instances, (3) she has asked for medical treatment, therefore, she cannot accept a part of it while cutting off the part that would be effective, and (4) she is, in truth, trying to starve herself to death and the state will not be a party to a suicide.”

     The Appellate Court considered, but rejected, the hospital’s arguments stated just above. In its highly controversial and strongly worded anti-paternalistic opinion, the Court of Appeal ruled:

          “The right to refuse medical treatment is basic and fundamental. It is recognized as a part of the right of privacy protected by both the state and federal constitutions. [citations to article I, § 1 of the California Constitution; as well as U.S. Supreme Court jurisprudence protecting a person’s substantive due process right to privacy respecting life and death decisions, announced in the landmark case Griswold v. Connecticut; and also, in prior decisions of the appellate courts of California in good standing, as in Bartling v. Superior Court (1984)] Its exercise requires no one’s approval. It is not merely one vote subject to being overridden by medical opinion.”

     In the section which immediately follows the above quotation (but which is also omitted by Vaughn in his abridged version of the opinion in the textbook) the Court goes on to recite the judicial origins of this now well-known doctrine of a patient’s right to refuse any unwanted part of prescribed medical treatment [you can find this part of the opinion, quoted here, at the upper right of page 2 of my Adobe Reader unabridged version]:

          “In Barber v. Superior Court, supra, 147 Cal. App. 3d 1006, . . . Justice Compton thoroughly analyzed and reviewed the issue of withdrawal of life-support systems beginning with the seminal case of the Matter of Quinlan (1976) 70 N.J. 10 [355 A.2d 647], cert. den. 429 U.S. 922 [. . . 97 S.Ct. 319], and continuing on to the then recent enactment of the California Natural Death Act (Health & Saf. Code, §§ 7185-7195). His opinion clearly and repeatedly stresses the fundamental underpinning of its conclusion, i.e., the patient’s right to decide: at page 1015, “In this state a clearly recognized legal right to control one’s own medical treatment predated the Natural Death Act. A long line of cases, approved by the [California] Supreme Court in Cobbs v. Grant (1972) 8 Cal. 3d 229 . . . have held that where a doctor performs treatment in the absence of an . . . informed consent, there is an actionable battery.”

     “Dean Prosser,” the California Supreme Court observed in their landmark Cobbs v. Grant opinion, “surveyed the decisions in this area and concluded, ‘The earliest cases treated this as a matter of vitiating the consent, so that there was liability for battery. Beginning with a decision in Kansas in 1960 [cite], it began to be recognized that this was really a matter of the standard of professional conduct . . . [T]he prevailing view now is that the action . . . is in reality one for negligence in failing to conform to the proper standard . . .” (. . . Prosser on Torts (4th ed. 1971) pp. 165-166.)”

     In any event, the L. A. hospital in the Bouvia matter had not proved, as they might have, that inasmuch as the patient had given general consent to be treated for her condition in a prescribed manner, the only issue was whether the patient was so clearly ill, or so emotionally distraught, as to foreclose a rational decision on her part in accepting or refusing the nasogastric feeding tube as a necessary part of the prescribed course of treatment, an argument that might have justified refusal to withdraw the feeding tube as contraindicated from a sound medical point of view.

     Elizabeth Bouvia was apparently capable of being effectively treated by the hospital to comparative health, hopefully long-lived. Her situation, therefore, was quite distinguishable from that of the patient in the case decided in 1976 by the New Jersey Supreme Court, in the Matter of Quinlan (1976), cited by the Court in Bouvia (as we observed above) for its reliance on the U.S. Supreme Court’s doctrine of a certain constitutional right to privacy. See Matter of Quinlan, 70 N.J. 10, at 38—40 (1976) [ Visit https://www.practicalbioethics.org/wp-content/uploads/2021/10/Case-Study-Matter-of-Quinlan.pdf  ]

     In the Matter of Quinlan, the New Jersey Supreme Court stated:

          “It is the issue of the constitutional right of privacy that has given us most concern, in the exceptional circumstances of this case. . . 
          “We have no doubt, in these unhappy circumstances, that if Karen were herself miraculously lucid for an interval . . . she could effectively decide upon discontinuance of the life-support apparatus, even if it meant the prospect of natural death. . .

          . . .
          “The Court in Griswold found the unwritten constitutional right of privacy to exist in the penumbra of specific guarantees of the Bill of Rights ‘formed by emanations from those guarantees that help give them life and substance’. 381 U.S. at 484, 85 S.Ct. at 1681 . . . [1965]. Presumably this right is broad enough to encompass a patient’s decision to decline medical treatment under certain circumstances, in much the same way as it is broad enough to encompass a woman’s decision to terminate pregnancy under certain conditions. Roe v. Wade, 410 U.S. 113, 153, 93 S.Ct. 705, 727 . . . (1973).”

     Be advised that though the Matter of Quinlan cites the landmark U.S. Supreme Court decision Roe v. Wade for its recognition of “the unwritten constitutional right of privacy,” the fact that Roe v. Wade has now been overruled (by Dobbs v. Jackson Women’s Health Organization, 597 U.S. 215, 142 S. Ct. 2228 (2022) as “incorrectly decided” in no way affects the Supreme Court doctrine of the constitutional right of privacy in general, or how that doctrine applies to either the New Jersey Supreme Court’s decision in in the Matter of Quinlan (1976) or the California Appellate Court’s decision in Bouvia v. Superior Ct. of L. A. County, 179 Cal. App. 3d 1127 (1986).

     The lead opinion for Roe v. Wade (1973) was written by Associate Justice Harry Blackmun. In later years Roe v. Wade was reaffirmed, with some modifications, in Planned Parenthood of Southeastern Pa. v. Casey (1992). In the Casey decision, Justice Blackmun, concurring with the majority of the Court in Part II of the opinion therein, at 505 U.S. 833, 926—930 (1992), wrote:

     “The Court today reaffirms the long-recognized rights of privacy and bodily integrity. As early as 1891, the Court held, “[n]o right is held more sacred, or is more carefully guarded by the common law, than the right of every individual to the possession and control of his own person, free from all restraint or interference of others. . .” Throughout this century, this Court also has held that the fundamental right of privacy protects citizens against governmental intrusion in such intimate family matters as procreation, childrearing, marriage, and contraceptive choice. . . These cases embody the principle that personal decisions that profoundly affect bodily integrity, identity, and destiny should be largely beyond the reach of government. . .”

     To be sure, the U.S. Supreme Court still recognizes “the unwritten constitutional right of privacy” as this fundamental right was enunciated in Griswold v. Connecticut, 381 U.S. 479, 85 S. Ct. 1678 . . . (1965). In Dobbs v. Jackson Women’s Health Organization, 597 U.S. 215, at 273, 142 S. Ct. 2228, at 2267, Slip Opinion at 48—49 (2022), the Court explains its judgment that the fundamental constitutional right to privacy was incorrectly applied to elective abortions in the (now overruled) Roe and Casey decisions:

          “. . . Citing a broad array of cases, the Court [in Roe v. Wade] found support for a constitutional ‘right of personal privacy’, id., at 152, but it conflated two very different meanings of the term: the right to shield information from disclosure and the right to make and implement important personal decisions without governmental interference. . . Only the cases involving this second sense of the term could have any possible relevance to the abortion issue, and some of the cases in that category involved personal decisions that were obviously very, very far afield. . .

          “What remained was a handful of cases having something to do with marriage, Loving, 388 U.S. 1 (right to marry a person of a different race), or procreation, Skinner, 316 U.S. 535 (right not to be sterilized); Griswold, 381 U.S. 479 (right of married persons to obtain contraceptives); Eisenstadt, 405 U.S. 438 (same, for unmarried persons). But none of these decisions involved what is distinctive about abortion:  its effect on what Roe termed ‘potential life’.”

     Our present concern is rather with “the unwritten constitutional right of privacy,” as this fundamental right was enunciated in Griswold v. Connecticut, 381 U.S. 479, 85 S. Ct. 1678 . . . (1965), a decision which remains in good standing.

     Subsequent to the United States Supreme Court opinion in Roe v. Wade, attention quickly turned to wide ranging consequences of the Court’s recognition of a patient’s “due process” liberty interest in privacy respecting personal decision-making autonomy regarding fundamental life and death decisions. Appellate court opinions, such as our instant matter, the case of Bouvia v. Superior Ct. of L. A. County, 179 Cal. App. 3d 1127 (1986), followed, upholding the doctrine that all patients possess a fundamental constitutional privacy interest in refusing any part of unwanted medical treatment.

     And later this rule of law was affirmed by the U.S. Supreme Court in Cruzan v. Director, Missouri Department of Health, 497 U.S. 261 (1990), a case in which the Court set the evidentiary standard of “clear and convincing evidence” of the patient’s intent as the legal burden of proof to be satisfied for purposes of ordering hospital compliance, the Supreme Court in that matter ruling further that the states may regulate compliance in accordance with certain legally sufficient “advance directives” in cases where the patient arrives at the hospital in a non-competent state (such as do-not-resuscitate requests, durable powers of attorney, and other requests refusing extraordinary emergency care to save their lives).