Barber v. Superior Court
147 Cal.App.3d 1006 (1983)
Rule of Law:
A physician has no legal duty to continue life-sustaining treatment, including artificial hydration and nutrition, for a patient who is in a persistent vegetative state once that treatment has proven ineffective and, in the opinion of qualified medical personnel, offers no reasonable hope of cognitive recovery. The withdrawal of such futile treatment, even if it hastens death, is considered a lawful omission and does not constitute murder.
Facts:
- Clarence Herbert underwent surgery performed by Dr. Robert Nejdl, with Dr. Neil Barber as his attending internist.
- Shortly after surgery, Herbert suffered a cardiorespiratory arrest, was revived, and was placed on life support equipment.
- Within three days, medical examinations revealed that Herbert had suffered severe brain damage, leaving him in a deep, permanent vegetative state with an extremely poor prognosis for recovery.
- Drs. Nejdl and Barber communicated this prognosis to Herbert's family.
- Herbert's family jointly signed a written request asking the hospital to remove 'all machines... that are sustaining life.'
- Following the family's request, the doctors ordered the removal of Herbert's respirator; he continued to breathe on his own but remained comatose.
- Two days later, after further consultation with the family, the doctors ordered the removal of the intravenous tubes that provided Herbert with hydration and nourishment.
- Herbert subsequently died.
Procedural Posture:
- Dr. Nejdl and Dr. Barber were charged with murder and conspiracy to commit murder in a criminal complaint filed in the Los Angeles Judicial District.
- Following a preliminary hearing, the magistrate dismissed the complaint against both doctors.
- The People (prosecution) filed a motion in the superior court to reinstate the complaint.
- The superior court judge granted the People's motion, concluding as a matter of law that the doctors' conduct was unlawful, and ordered the complaint reinstated.
- The petitioners, Dr. Nejdl and Dr. Barber, filed petitions for a writ of prohibition with the California Court of Appeal to restrain the superior court from proceeding with the prosecution.
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Issue:
Does a physician's withdrawal of life-sustaining hydration and nutrition from a comatose patient, at the request of the patient's family, constitute an unlawful killing for the purposes of a murder charge when medical diagnosis indicates the patient is in a persistent vegetative state with no reasonable hope of cognitive recovery?
Opinions:
Majority - Compton, J.
No. A physician's withdrawal of life-sustaining treatment from a comatose patient with no reasonable chance of cognitive recovery is not an unlawful killing but rather a lawful omission to provide further treatment where no legal duty to continue exists. Murder is defined as an unlawful killing. The court characterized the cessation of life-sustaining measures, including intravenous hydration and nutrition, as a passive omission of further medical treatment, not an affirmative act. Criminal liability for an omission arises only when there is a legal duty to act. A physician's duty is to provide effective care, and this duty ceases when treatment becomes futile—that is, when it cannot improve the patient's prognosis for recovery. The court found no meaningful distinction between a mechanical respirator and intravenous feeding, viewing both as medical procedures that may be discontinued if their burdens outweigh their benefits. This determination should be guided by a 'proportionate treatment' analysis, where the focus is on the reasonable possibility of the patient's return to a cognitive and sapient life. When a patient is incompetent, the decision can be made by a surrogate, such as the family, based on the patient's best interests or previously expressed wishes, without the necessity of prior judicial approval.
Analysis:
This case was a landmark decision that provided critical legal protection for physicians in the context of end-of-life care. By classifying the withdrawal of futile life support as a lawful omission rather than an affirmative act of homicide, the court distinguished these medical decisions from illegal euthanasia. This ruling established that medical professionals do not have a duty to prolong biological life indefinitely when there is no hope of recovery, thereby empowering families and doctors to make compassionate decisions without fear of criminal prosecution. The decision significantly influenced the development of medical ethics and law regarding incompetent patients, affirming the role of family surrogates and shaping the legal framework for withdrawing treatment in the absence of specific legislation.
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