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January 1986

The Case of Elizabeth Bouvia: Starvation, Suicide, or Problem Patient?

Author Affiliations

From the Divisions of General Internal Medicine (Drs Steinbrook and Lo) and Medical Ethics (Dr Lo), Department of Medicine, University of California, San Francisco.

Arch Intern Med. 1986;146(1):161-164. doi:10.1001/archinte.1986.00360130199026

In the summer of 1983, Elizabeth Bouvia, a 26-year-old woman physically incapacitated by cerebral palsy, checked into Riverside (Calif) General Hospital, saying that she wanted to starve to death. More than seven months later, she changed her decision. In a motel room in Tijuana, Mexico, Bouvia renounced her wish to die and ate solid food. This case attracted the interest of physicians, disabled individuals, and the public at large. Dramatic charges and countercharges were widely publicized. We shall discuss several issues. First, was Bouvia exercising the competent patient's right to make decisions about her medical care or was she demanding that her physicians assist in her suicide? Second, what role should external interests, such as those of handicapped individuals, medical professionals, or society at large, have in medical decisions for patients like Bouvia? Third, is refusing food and water different from declining other care? Finally, how can physicians care

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