McKay v. Bergstedt
106 Nev. 808, 1990 Nev. LEXIS 156, 801 P.2d 617 (1990)
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Rule of Law:
A competent, non-terminal adult with an irreversible, debilitating condition who is sustained by artificial life support has a constitutional liberty interest and a common law right to refuse or discontinue such life support, and this right generally outweighs the state's interest in preserving life when the patient is enduring significant physical and mental suffering.
Facts:
- At age ten, Kenneth Bergstedt suffered a swimming accident that rendered him a quadriplegic.
- For the following 21 years, Bergstedt was dependent on a respirator to breathe.
- Bergstedt's father, who was his primary caregiver and sole surviving parent, became terminally ill.
- Fearing the quality of his life after his father's imminent death and being cared for by strangers, Bergstedt decided he wanted his respirator removed.
- A neurosurgeon confirmed that Bergstedt's quadriplegia was irreversible.
- A psychiatrist examined Bergstedt and found him to be mentally competent and to fully understand the consequences of his decision.
- Bergstedt was not terminally ill, so long as he continued to use the respirator.
Procedural Posture:
- Kenneth Bergstedt petitioned the district court for an order permitting the removal of his respirator and the administration of a sedative.
- Bergstedt also sought an order granting immunity from civil or criminal liability for anyone assisting him and a declaration that his death would not be a suicide.
- The State of Nevada was the respondent but took a non-adversarial position in the proceedings.
- The district court ruled in favor of Bergstedt, finding he had a constitutional privacy right to discontinue medical treatment which outweighed any state interests.
- The State of Nevada appealed the district court's decision to the Supreme Court of Nevada.
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Issue:
Does a competent, non-terminal adult quadriplegic, who is dependent on a life-sustaining respirator and fears a future of suffering, have a constitutional liberty interest and common law right to have the respirator removed, which outweighs the State's interests in preserving life, preventing suicide, protecting third parties, and maintaining the integrity of the medical profession?
Opinions:
Majority - Steffen, J.
Yes. A competent adult's liberty interest under both the federal and Nevada constitutions, reinforced by the common law right of self-determination, allows them to refuse or discontinue life-sustaining medical treatment when their quality of life is dismal, and this interest outweighs countervailing state interests. The court balances the individual's right against five state interests: (1) preserving life, (2) preventing suicide, (3) protecting innocent third parties, (4) preserving medical integrity, and (5) encouraging humane care. The state's interest in preserving life is not absolute and decreases as the quality of a patient's life diminishes. The court determined that withdrawing life support to allow a natural death is not suicide, as it does not involve an affirmative, self-inflicted act but rather removes an artificial barrier to the natural consequences of a pre-existing condition. Because Bergstedt was a competent adult with no dependents, and his decision did not threaten medical ethics, his right to decide based on his own perception of his quality of life was paramount.
Dissenting - Springer, J.
No. The court lacked judicial power because there was no genuine case or controversy, and even if jurisdiction existed, a court should not authorize what is effectively a state-assisted suicide. The dissent argues that the State's non-adversarial position meant the court was deprived of a balanced debate on a critical issue. Furthermore, removing the ventilator was not merely refusing 'treatment' but a direct act causing the death of a non-terminal person. The ventilator had become an integral part of Bergstedt's life, and its removal constituted a 'killing act.' Sanctioning this act for a disabled person creates a dangerous precedent and blurs the line with assisted suicide, a complex policy matter that should be addressed by the legislature, not the judiciary.
Concurring - Mowbray, J.
Yes. The district court's decision was correct, but the majority opinion went too far. The concurrence agrees only with the result of affirming the lower court's judgment that permitted Bergstedt to have his life support removed. It strongly objects to the majority's creation of a detailed procedural framework for future cases, arguing that establishing such a comprehensive scheme is a legislative function. Creating a system that places life-or-death decisions in the hands of 'non-attending physicians' by 'judicial fiat' is an overstep of judicial authority and should be left to the legislature.
Analysis:
This landmark Nevada case establishes a competent but non-terminal individual's right to refuse life-sustaining treatment based on a subjective assessment of their own quality of life. The court's decision expands the 'right to die' jurisprudence beyond terminally ill patients, focusing on individual autonomy and the right to avoid a life of perceived suffering. By creating a detailed, extra-judicial procedural framework, the court attempts to streamline these decisions and avoid costly litigation, though this move was criticized as judicial overreach into the legislative sphere. The case highlights the legal distinction between allowing a natural death by refusing treatment and the act of suicide, a central tension in right-to-die cases.
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