Legal Right to Refuse Medical Treatment California
The California Legislature has also recognized the right to control one's own medical treatment as a fundamental right, by declaring it so, in connection with the Natural Death Act, Health and Safety Code, section 7185.5, which authorizes advance directives for health care decisions (an enactment not at issue in this case). (Drabick, supra, 200 Cal. App. 3d at p. 206.)
The constitutional basis for the individual's right to determine the scope of his or her own medical treatment derives in California from the privacy provision of California Constitution, article I, section 1, which provides: "All people are by nature free and independent and have inalienable rights.
Among these are enjoying and defending life and liberty, acquiring, possessing, and protecting property, and pursuing and obtaining safety, happiness, and privacy." (See Drabick, supra, 200 Cal. App. 3d at p. 206, fn. 20.) Drabick cited Bouvia v. Superior Court (1986) 179 Cal. App. 3d 1127, 1137-1138, 225 Cal. Rptr. 297, which in turn cited both the state and federal Constitutions.
However, the United States Supreme Court has recently indicated its preference to regard the right to make health care decisions as a Fourteenth Amendment liberty interest, rather than a privacy interest under the federal Constitution. (Cruzan v. Director, Mo. Health Dept. (1990) 497 U.S. 261, 279, fn. 7 [111 L. Ed. 2d 224, 242, fn. 7, 110 S. Ct. 2841].)
Cruzan assumed, without deciding, that the liberty interest in refusing medical treatment includes the right to refuse life-sustaining nutrition and hydration. (Id. at p. 279 [111 L. Ed. 2d at p. 242] [Missouri requirement that incompetent's wishes as to withholding of life-sustaining treatment be proved by clear and convincing evidence did not violate due process].)
We need not decide any question of a liberty interest, because we resolve this case as a matter of privacy interest under the California Constitution, and although appellants refer to the liberty interest, they do not show that it adds anything helpful to their position, beyond the privacy interest under the California Constitution.
"While fundamentally compelling, the right to be free from nonconsensual invasions of bodily integrity is not absolute.
Four state interests generally identify the countervailing considerations in determining the scope of patient autonomy: preserving life, preventing suicide, maintaining the integrity of the medical profession, and protecting innocent third parties." (Thor v. Superior Court, supra, 5 Cal. 4th at p. 738 [competent, quadriplegic prison inmate has right to refuse medical treatment including sustenance].)
Generally, the state's interest in preserving life does not outweigh the individual's right to choose.
"The state has not embraced an unqualified or undifferentiated policy of preserving life at the expense of personal autonomy.
As a general proposition, 'the notion that the individual exists for the good of the state is, of course, quite antithetical to our fundamental thesis that the role of the state is to ensure a maximum of individual freedom of choice and conduct." ( Thor v. Superior Court, supra, 5 Cal. 4th at p. 740.)
"The fact that an individual's decision to forego medical intervention may cause or hasten death does not qualify the right to make that decision in the first instance.
Particularly in this day of sophisticated technology, the potential medical benefit of a proposed treatment is only one of the factors a patient must evaluate in assessing his or her perception of a meaningful existence.
Since death is the natural conclusion of all life, the precise moment may be less critical than the quality of time preceding it.
Especially when the prognosis for full recovery from serious illness or incapacitation is dim, the relative balance of benefit and burden must lie within the patient's exclusive estimation:
'That personal weighing of values is the essence of self-determination.' [Citations.]" (Thor v. Superior Court, supra, 5 Cal. 4th at p. 739.)