Citation
147 Cal.App.3d 1006, 195 Cal.Rptr. 484 (Cal. Ct. App. 1983)
Facts of Barber v Superior Court
Clarence Herbert, the deceased, suffered a cardiorespiratory arrest during surgery, leaving him in a deeply comatose state with severe and likely irreversible brain damage. Following his condition’s prognosis, medical professionals placed Herbert on life-support equipment to sustain his basic bodily functions.
Subsequently, Herbert’s physicians, Dr. Robert Nejdl (surgeon) and Dr. Neil Barber (internist), informed Herbert’s family of his poor chances of recovery. After a consultation and a written request from the family, the doctors removed the life-sustaining equipment. Herbert continued breathing but exhibited no signs of improvement. Shortly afterward, the doctors also ceased providing intravenous hydration and nourishment, ultimately leading to Herbert’s death.
Drs. Nejdl and Barber were charged with murder and conspiracy to commit murder based on their decision to discontinue treatment. Initially, the magistrate dismissed the charges, concluding that the doctors’ actions were not criminal. However, the Superior Court of Los Angeles reinstated the complaint. The physicians then petitioned the California Court of Appeal for a writ of prohibition to restrain the Superior Court from proceeding further.
Issue
Whether a physician’s decision to discontinue life-sustaining treatment, at the request of the patient’s family and based on medical futility, constitutes murder or conspiracy to commit murder under California law.
Procedural History
- Initial Charges: Drs. Nejdl and Barber were charged with murder and conspiracy to commit murder following Herbert’s death.
- Dismissal by Magistrate: The charges were dismissed by the magistrate, who found no basis for criminal liability.
- Reinstatement by Superior Court: The Superior Court of Los Angeles County reinstated the complaint against the physicians under Penal Code section 871.5.
- Petition for Review: The physicians petitioned the California Court of Appeal to issue a writ of prohibition to prevent further proceedings on the reinstated charges.
Barber v Superior Court Judgment
The California Court of Appeal in Barber v Superior Court held that the writ of prohibition should issue, thereby restraining the Superior Court from taking further action other than to vacate its order reinstating the complaint. The court concluded that the cessation of life support by Drs. Nejdl and Barber did not constitute an unlawful killing and was not punishable under the penal code.
Reasoning in Barber vs Superior Court
The Court of Appeal’s reasoning was grounded in several key principles:
Distinction Between Acts and Omissions
The court in Barber v Superior Court categorized the physicians’ actions as omissions (failure to continue treatment) rather than affirmative acts (causing death). It emphasized that criminal liability for an omission requires a legal duty to act. The court found that the doctors had no legal obligation to continue life-sustaining treatment once it was determined to be medically futile.
Legal Duty and Medical Futility
The court ruled that physicians are not legally obligated to administer treatment that is ineffective or contrary to the wishes of the patient or their family. The doctors’ decision to discontinue treatment was based on sound medical judgment and family consultation, making it ethically and legally permissible.
Patient Autonomy
The court highlighted the legal principle that a competent adult has the right to refuse medical treatment. In cases where the patient is incapacitated, the patient’s immediate family may exercise this right on their behalf. Since Herbert’s family requested the withdrawal of life support, the physicians acted in accordance with their wishes.
Nature of Life-Sustaining Treatment
The court distinguished between medical interventions such as providing hydration and nutrition via intravenous means and basic care. It deemed these interventions as medical procedures subject to evaluation based on their benefits and burdens.
Murder Defined
Murder is defined as the unlawful killing of a human being with malice aforethought. The court concluded that the withdrawal of life support did not amount to an unlawful killing, as it was a medically and ethically justified omission.
Call for Legislative Guidance
The court acknowledged the lack of legislative clarity on the moral, social, and legal implications of withdrawing life support. It urged lawmakers to address these complex issues to provide clear guidance for future cases.
Conclusion
The Barber v Superior Court case is a landmark decision that balances the legal, ethical, and medical dimensions of end-of-life care. By distinguishing between acts and omissions, the court upheld the principle that withdrawing futile treatment is not a criminal act. The ruling reinforces patient autonomy, respects the role of family decision-making, and provides clarity for medical professionals navigating complex ethical dilemmas.
However, it also highlights the need for legislative action to address the broader implications of such cases. As a precedent, the Barber vs Superior Court continues to shape the legal and ethical landscape of healthcare, offering valuable guidance for future disputes involving end-of-life decisions.