Bartling v. Superior Court

Citation163 Cal.App.3d 186,209 Cal.Rptr. 220
CourtCalifornia Court of Appeals
Decision Date27 December 1984
PartiesWilliam Francis BARTLING and Ruth Cheryl Bartling, Petitioners and Appellants, v. SUPERIOR COURT of the State of California For the County of Los Angeles, Respondent, GLENDALE ADVENTIST MEDICAL CENTER, et al., Real Parties in Interest. Civ. B007907.

Malley, Yelsky, Rosenfeld & Scott, Stephen A. Malley, Beverly Hills, Jacquie M. Scheck, Certified Law Student, George J. Annas and Leonard H. Glantz, Boston, Mass., by Richard Stanley Scott, Beverly Hills, for petitioners.

Wood, Lucksinger & Epstein, Gerald W. Connor and George James Stephan by William H. Ginsburg, Los Angeles, for real party in interest.

Fenella Rouse, Pro Hac Vice, N.Y., and Hufstedler, Miller, Carlson & Beardsley, Los Angeles by Leonard L. Gumport, Pasadena, and Michael Feuer, San Bernardino, for amicus curiae, The Society for the Right to Die, Inc.

Griffith David Thomas, Sherman Oaks, Brad D. Selgestad, Fred Okrand and Paul Hoffman, Los Angeles, for amicus curiae, ACLU Foundation of Southern California.

HASTINGS, Associate Justice.

In this case we are called upon to decide whether a competent adult patient, with serious illnesses which are probably incurable but have not been diagnosed as terminal, has the right, over the objection of his physicians and the hospital, to have life- support equipment disconnected despite the fact that withdrawal of such devices will surely hasten his death.

Petitioners are William Bartling and his wife, Ruth Bartling. Real parties in interest are the Glendale Adventist Medical Center ("Glendale Adventist") and Mr. Bartling's treating physicians.

The ruling challenged in this petition is the denial of petitioners' request for an injunction ordering real parties to disconnect Mr. Bartling's ventilator (commonly called a "respirator"), a machine which sustains the patient's breathing. Although petitioners filed an appeal from the Superior Court's order, they also filed the within petition, claiming that the situation was too urgent to await the appeal. Petitioners were unfortunately correct, for Mr. Bartling passed away the afternoon before the hearing on this petition.

Both sides in this case have urged us to address the merits of the petition and formulate guidelines which might prevent a reoccurrence of the tragedy which befell Mr. Bartling. We agree that in light of the important questions raised, this court should exercise its discretion to render an opinion in this case despite its mootness. (Daly v. Superior Court, 19 Cal.3d 132, 141, 137 Cal.Rptr. 14, 560 P.2d 1193.) "The novel medical, legal and ethical issues presented in this case are no doubt capable of repetition and therefore should not be ignored by relying on the mootness doctrine. This requires us to set forth a framework in which both the medical and legal professions can deal with similar situations." (Dority v. Superior Court, 145 Cal.App.3d 273, 276, 193 Cal.Rptr. 288.)

At the time of his death, Mr. Bartling was 70-years-old and suffered from emphysema, chronic respiratory failure, arteriosclerosis, an abdominal aneurysm (abnormal ballooning of the main artery passing through the abdomen to the legs), and a malignant tumor of the lung. Mr. Bartling also had a history of what real parties term "chronic acute anxiety/depression" and alcoholism.

Mr. Bartling entered Glendale Adventist on April 8, 1984, for treatment of his depression. A routine physical examination, including a chest x-ray, was performed, and a tumor was discovered on Mr. Bartling's lung. A biopsy of the tumor was performed by inserting a needle in the lung, which caused the lung to collapse. Tubes were inserted in Mr. Bartling's chest and through his nasal passage and throat in order to reinflate his lung. Because of his emphysema, the hole made by the biopsy needle did not heal properly and the lung did not reinflate. While Mr. Bartling was being treated with antibiotics to promote healing of the lung, a tracheotomy was performed and he was placed on a ventilator. Mr. Bartling remained on the ventilator until the time of his death, and efforts to "wean" him from the machine were unsuccessful.

On several occasions in April, Mr. Bartling tried to remove the ventilator tubes. To prevent accidental or deliberate disconnection of the ventilator tubes (or any of the other tubes to which he was attached), Mr. Bartling's wrists were placed in "soft restraints." Despite requests from both Mr. and Mrs. Bartling, Glendale Adventist and Mr. Bartling's treating physicians refused to remove the ventilator or the restraints.

In June of this year, petitioners filed a complaint (subsequently amended) in the Superior Court seeking damages for battery (unconsented medical treatment), violation of state and federal constitutional rights, breach of fiduciary duty on the part of Glendale Adventist and Mr. Bartling's treating physicians, intentional infliction of emotional distress, and conspiracy. Petitioners sought an injunction restraining real parties from administering any unconsented medical care to Mr. Bartling. This included "forcing Plaintiff to undergo mechanical breathing through the ventilator" and other medical procedures. 1 Attached to the complaint were:

(1) A "living will," signed by Mr. Bartling with an "X" and properly witnessed, which stated in part: "If at such time the situation should arise in which there is no reasonable expectation of my recovery from extreme physical or mental disability, I direct that I be allowed to die and not be kept alive by medications, artificial means or heroic measures."

(2) A declaration from Mr. Bartling in which he stated in part: "While I have no wish to die, I find intolerable the living conditions forced upon me by my deteriorating lungs, heart and blood vessel systems, and find intolerable my being continuously connected to this ventilator, which sustains my every breath and my life for the past six and one-half (6 1/2) weeks. Therefore, I wish this Court to order that the sustaining of my respiration by this mechanical device violates my constitutional right, is contrary to my every wish, and constitutes a battery upon my person. I fully understand that my request to have the ventilator removed and discontinued, which I have frequently made to my wife and to my doctors, will very likely cause respiratory failure and ultimately lead to my death. I am willing to accept that risk rather than to continue the burden of this artificial existence which I find unbearable, degrading and dehumanizing. I also suffer a great deal of pain and discomfort because of being confined to bed, being on this ventilator, and from the other problems which are occurring."

(3) A "Durable Power of Attorney for Health Care," 2 executed by Mr. Bartling, appointing Mrs. Bartling as his attorney-in-fact. In this document, Mr. Bartling stated in part: "My desires concerning future medical and supportive care, which I direct my attorney-in-fact to follow, are as follows: ... I am totally unable to care for myself, and believe that I am dependent on a mechanical ventilator to support and sustain my respiration and life. I continuously suffer agonizing discomfort, pain and the humiliating indignity of having to have my every bodily need and function tended to by others. I do not wish to continue to live under these conditions. It is therefore my intent to refuse to continue on ventilator support and thereby to permit the natural process of dying to occur--peacefully, privately and with dignity. I direct my attorney-in-fact to honor my desires in this regard, and to refuse ventilator support, at such time as I am unable to do so for myself. I am aware that impairment, incapacity and unconsciousness may occur as a result of my refusal of ventilation, but I desire that none of these be deemed to be a medical emergency."

Mr. and Mrs. Bartling and Mr. Bartling's daughter Heather all executed documents in which they released Glendale Adventist and its doctors from any claim of civil liability should the hospital and doctors agree to honor Mr. Bartling's wishes.

Despite these strong and unequivocal statements from Mr. Bartling and his family, his treating physicians refused to remove the ventilator and refused to remove the restraints which would allow Mr. Bartling to disconnect the ventilator himself should he choose to do so.

In support of their application for injunction and this petition, petitioners supplied declarations to support their contentions that (1) Mr. Bartling had a relatively short time to live, even with the ventilator; (2) he was competent to direct what medical treatment he would or would not receive; and (3) it would not be unethical for Mr. Bartling's treating physicians to honor his wishes, even if it meant disconnection of a life-sustaining machine.

Mr. Bartling's videotape deposition was taken on the day before the Superior Court hearing, June 21. Mr. Bartling could not speak but could nod or shake his head to indicate yes or no answers. Mr. Bartling said that he wanted to live, but did not want to live on the ventilator. He did understand that if the ventilator were removed he might die.

It was the opinion of Mr. Bartling's treating physicians, presented to the trial court by way of declarations, that Mr. Bartling's illness was not terminal and that he could live for at least a year if he was "weaned" from the ventilator. However, the doctors opined in their declarations that "weaning was unlikely because of his medical and psychological problems that were not under control."

Although they did not challenge his legal competency, the doctors and Glendale Adventist questioned Mr. Bartling's ability to make a meaningful decision because of his vacillation. This opinion was based on the declarations of several nurses who related instances in which the ventilator tube accidentally detached and Mr. Bartling...

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