Court Opinion

ID: 9631106
Source: CourtListenerOpinion
Date Created: 2023-08-22 10:29:28.307261+00
Date Added: 2024-06-11T18:07:48.956866
License: Public Domain

Springer, J.,
dissenting:
I dissent on two grounds. The first ground is that there was no real case or controversy before the district court. Therefore, it had no judicial power to decide that Kenneth Bergstedt could lawfully take his own life or that another person could lawfully assist him in taking his life. The second ground is that even if this had been a true case instead of a show case, it would not be a proper exercise of judicial power for a court to authorize one person to take the life of another person.
I.

Absence of Judicial Power

Article 6, section 6 of the Nevada Constitution gives to the district court the power to decide “cases.” This is not a case. A case is defined as a “controversy, at law or in equity; a question contested before a court of justice.”1 As this court has put it, the exercise of judicial power must be “confined to controversies in the true sense. The parties must be adverse . . . .”2 There is no *832controversy here. The state’s attorney even went so far as to tell the trial court that “there does not appear to be any controversy between the attorney general’s office and Mr. Bergstedt.” I do not want to belabor the point because it is so obvious. There has never been any controversy here and no “question contested before a court of justice” because at all times, even on appeal, everyone has been in cordial agreement as to what the outcome was going to be.
Not only did the nonadversarial, nonantagonistic posture of this case deprive the trial court of its constitutional power to decide the claims presented by Mr. Bergstedt, it deprived the court of the truth-seeking benefits ordinarily attached to the adversary system. This is an agonizingly difficult case and a unique one, a case desperately in need of a two-sided debate. If there had been a life-side versus a death-side to this case, surely the life-side would at least have raised the point that the plaintiff’s case must fail because it sought court approval of a “killing act,” an act which knowingly caused the immediate death of a human being. As I indicate below, this would have been a strong argument to be made under the circumstances of this case. I know of no court that has adopted a rule which sanctions suicide3 by a conscious, competent and alert human being who was not dying and who was expressing a frank desire for immediate self-destruction.4 There are a number of novel and perplexing ques*833tions to be answered in this case. I certainly would have had an easier time in dealing with these questions if they had been properly and adversarily litigated in the court below.
The trial court did not have the constitutional power to decide a “noncontroversy” and then to take the action that it did; but even if this had been a real case, I maintain that the trial court had no power to sanction or facilitate by court decree Kenneth Bergstedt’s announced plan to take his own life by means of the mortal killing act of taking away his breathing apparatus. The Nevada Supreme Court’s affirmance of the district court’s decree “may make it law, but it does not make it true.”5
II.

State-Assisted Suicide: Our “Clouded Ability to Assess the Suicidal Basis of Mr. Bergstedt’s Request to Die”

[V]alue judgments . . . about the worth of Mr. Bergstedt’s life have clouded [the] ability to properly assess the suicidal basis for Mr. Bergstedt’s request to die ... .6
As I have already suggested, having the benefit of arguments on only one side of any controversy is a severe limitation upon decision-makers’ ability to arrive at an informed and just decision. This limitation has in no small measure “clouded” the truth and the ability of almost everyone to “assess the suicidal basis of Mr. Bergstedt’s request to die.” Added to the “one-sidedness” of this case are other “clouding” factors that I think may well have affected its outcome: the extremely dramatic and sympathetic nature of Mr. Bergstedt’s plea for mercy; faulty reliance on “right-to-die” cases which deal with the comatose and the terminally ill and have no application here; and, cloudiest of all, the flawed impression that persons whose lives depend on life-sustaining devices may kill themselves at will, merely by calling removal of essential-to-life machines a refusal to accept unwanted “medical treatment” or by calling their users’ immediate and directly resultant demise a “natural death.”
*834I see Kenneth Bergstedt’s breathing device as being more than “medicine.” It is true that the machine was introduced during a medical emergency by medical personnel. It is true also that medical and mechanical monitoring of the device must be continued and that medical personnel or paramedical personnel are required to fulfill the daily needs of persons in this kind of condition. Notwithstanding all of this, I cannot escape the conclusion that, after twenty-three years of living and breathing in this machine-aided manner, the whole process becomes something quite more than mere medical treatment. The mechanical breather becomes a new way of life for its user, and life cannot go on without it. Mr. Bergstedt lived at home. The “treatment” in any real sense is over; and just as heart pace-makers, artificial venous or arterial shunts, a variety of prosthetic devices and other such medically sponsored and introduced artifacts may begin as a medical treatment modality, the ventilator begins as a form of medical treatment but ends up as an integral part of its dependent user. Even if it is insisted that these things continue indefinitely to be considered as “treatment,” they indeed become far, far more than just treatment after years and years of dependency on them.
When Kenneth Bergstedt asked the court to give legal sanction to the death-inducing act of disconnecting his breathing apparatus, he was not to my mind merely exercising his “right to be let alone,”7 and his right to refuse unwanted medical treatment. Withdrawal of medicine or so-called “life support” may be a humane way of letting nature take its course in the lives of the near-dead or irreversibly comatose, but it is a different matter when withdrawal of these items is admitted to be the immediate and proximate cause of the death of a person who concededly is seeking to take his own life.
Use of the term “natural death” in this case is only a natural and understandable way of averting the excruciating truth. Bergstedt’s explicit and express desire and intention was that of putting an immediate end to his own life. That is not what one would call a “natural death.” There was nothing natural about Mr. Bergstedt’s death; he killed himself. Masking this unpleasant but inescapable fact has the unfortunate result of masking the really hard question presented by this case, and that is this: If, when and how should a person in Kenneth Bergstedt’s condition (or perhaps other comparable conditions) be given legal permission to have outside assistance in taking his own life, without the incurrence of civil or criminal liability by anyone involved in the *835process? By avoiding the question, we avoid the answer; and by avoiding the answer, we invite future agonies suffered by persons like Mr. Bergstedt, who, in my view, was not given an acceptable solution to his plight. Mr. Bergstedt is dead now, and this may let us look at these cases in a more dispassionate way and address the problems presented by this case in a proper and rational manner.
Once again: In light of his expressed intentions and in view of the direct and active way in which he chose to end his own life, Mr. Bergstedt cannot be said to have died a “natural death.” Mr. Bergstedt’s “injuries, though perhaps permanent, have not incapacitated Mr. Bergstedt completely. He is not ‘terminally ill’ or otherwise close to death. His request to forego mechanical respiration has been made in a context suggesting that his intent may be suicidal . . . .”8 Mr. Bergstedt was not dying, except in the sense that we are all dying, and he was not in the least danger of imminent death. He had been living steadily for over twenty-three years, breathing with the aid of a ventilator, until he reached a time in his life when he decided to die because, like most other suicides, life had become, temporarily at least, intolerable for him. The means by which he chose to take his own life was to have someone remove his breathing device during a time that he was sedated for the calculated purpose of bringing his life to a painless end. The result of the ventilator’s removal, known to him and to everyone concerned, was immediate death. Withholding the ventilator was for this man not a withholding of medical treatment, it was the withholding of life itself.
If we reflect for a moment on the nature and use of this ventilator, it does not take long to see that the machine had become an integral part of Mr. Bergstedt’s person and was not mere “treatment.”
Life support systems such as ventilators, electric wheelchairs, or other automated devices enhancing one’s functions are real extensions of the person, and should be treated as such. Persons with disabilities use “artificial” supports as a matter of daily course, and find them vital to carrying on their productive lives. Mr. Bergstedt’s ventilator should not be transformed into a form of extraordinary support because his father is in ill health and Mr. Bergstedt thus far has not received appropriate professional and peer assistance in coping with personal fears.9
(My emphasis.)
Kenneth Bergstedt did not want to die a “natural” death; he *836wanted to die an immediate death. He sought an immediate death by means of disconnecting the “extension of his person” that had enabled him to live and breathe for the preceding twenty-three years. Construing the ventilator in this case as a “form of extraordinary support” that can be removed at will is a terrible and terrifying rationalization and, as well, a prejudicial treatment of Mr. Bergstedt because his assisted suicide was sanctioned and facilitated only because of his disabled condition.
It is crucial that the court not put its judicial stamp of approval on negative stereotypes about disability. This would result if it were to allow the state to assist an individual to die only because he or she has a disability. Judicial decisions which are based upon societal prejudices merely reinforce those prejudices, making them even more difficult to eradicate.10
I register now my strong disapproval of our court’s putting their “judicial stamp of approval” on allowing “the state to assist an individual to die only because he . . . has a disability.” What other conditions, physical or mental, I ask myself, will be brought to the courts as grounds for judicially approved and assisted self-destruction? We now have a growing population of people who are alive but throughout history would have been dead. Some live under conditions under which many if not most of us would probably not want to survive; yet there are those who do survive and who continue to survive under the most trying of circumstances. The distinguishing aspect of the described persons is that, unlike most of us, they do not have, because of their paralytic condition, the power to bring their lives to an end, however intolerable their lives might become. They are trapped. Life is thrust upon them — forced upon them. If a person like Mr. Bergstedt comes to the courts saying, “I have come to the end of my rope; I cannot stand it any more; you must give me the means to end my own life in peace and in dignity”; it is difficult indeed to say “no.” Unfortunately it does not belong to the judicial realm to say “yes.” The judicial department of government is not the proper agency to address the novel and perplexing question presented here, namely, the question of under what, if any, circumstances should a right to state-assisted suicide be granted. Although not called upon to do so by the writing of this dissent, I have some more to say on the subject.
*837III.

A “Right” to State-Assisted Suicide?

I know of no judicially created or other legal “right” to commit suicide or to have court-ordered assistance in carrying out one’s self-destruction. Although suicide is not a crime in Nevada or in any other state, there is certainly a strong enough public policy against suicide to preclude the courts from assisting in its enactment. Further, it is most certainly a crime to conspire to commit suicide or to aid and abet a suicide. Our law of crimes is legislative, and no statutory crime should be abolished or absolved without legislative enactment or repeal.
The issues presented here, though unique in many respects, are only part of a whole array of social, ethical, theological and legal problems that have come to us through the advancements of medical science. Until very recently in our history this kind of predicament was, necessarily, not a matter that was subject to being dealt with by our law. We have here a man whose consciousness was entombed in a body immobile. Unlike most of the readers of this opinion, Mr. Bergstedt did not have the power to end his life by himself, no matter how tortured his life became. If I am not mistaken, the technical ability to keep a person with these kinds of injuries alive by means of mechanical respiration has not been available for much more than fifty years. When we are faced with protecting the interests and dignity of a person like Mr. Bergstedt, we are dealing with a problem completely unknown and probably unthinkable to the law throughout most of its history. Still, there is a history of suicide in the law and even a history of state-sanctioned suicide. This might be useful to us in thinking through the problem at hand.
Although ancient Greece and Rome opposed suicide, and sanctions were imposed on the properties of those who committed suicide, laws were enacted in both Greece and Rome which excused suicide under certain circumstances. These societies provided for access to the courts for the purpose of hearing the applications of persons who were desirous of quitting life; and the courts could grant or refuse permission in each case as they saw fit. In the margin I have included a relatively modern commentary on this subject.11 I bring this up only to show that in times past societies did grant state approval for certain kinds of self-*838destruction under certain kinds of circumstances and to show that the problem facing us today is not an entirely new one and perhaps only a new twist on a very old problem. It seems reasonable to assume that a Roman or Grecian court would find Mr. Bergstedt’s plea to end his life to be one justified under their laws. As I have maintained throughout, however, this is a matter for our democratically-elected representatives in the legislature. They are the ones who must answer these questions and particularly the pressing and specific question: What are we going to do about a totally paralyzed person who is undergoing the unbearable suffering that continued consciousness brings, and who wants desperately to bring his life to an end but does not have the physical capability of doing it?
IV.

Conclusion

It is not death, it is the dying that alarms me.
Montaigne
I want to be sure that the reader of this dissent does not get this case mixed up with the “right-to-die” cases in which there is present either imminent death or permanent unconsciousness. We are not dealing here with “overtreatment” or unwanted prolongation of the dying process. Kenneth Bergstedt was severely paralyzed and ventilator-dependent and suffered from what neurologists self-descriptively call the “locked-in syndrome”; but his consciousness was intact, and he had a life-expectancy of indefinite duration. It is unclear, however, whether his decision to take his own life was completely rational or possibly a product of some kind of clinically identifiable depression. The mentioned Mr. Marzen points out that Mr. Bergstedt was completely lacking in positive support, that all input was one-sided, all death and no life. According to Mr. Marzen,12 Mr. Bergstedt was a man with *839“a one sided support system of persons who espouse the erroneous view that, in the words of [psychiatrist] Dr. Jurasky, ‘[t]he quality of life for this man is . . . forever profaned by a future which offers no relief and only the possibility of worsening.’” With this kind of support it is no wonder that he decided to do himself in.
I have agonized over this case. At one moment I am haunted by the picture of a hopeless, wretched and tortured person who has no desire except to end his suffering by ending his life. As we know, however, he did not have it within his capacity to end his life, so that he must live on, “locked” into a condition which at the time of his death Mr. Bergstedt probably saw as one of intolerable and unrelenting misery. How can any one who can help him possibly turn down his plaint? But, then, we are not even sure of the exact nature of his mental and emotional condition, or that his depression was not a temporary one, as suggested by Mr. Marzen. In this case we will never know the truth because we heard only one side of the case, namely, Mr. Bergstedt’s unopposed claim to the “right” to put an abrupt end to his life. Even if we assume, however, that Mr. Bergstedt’s death wish was not generated by a one-sided support system and depression, my views of this case would remain the same.
As I have said, I know in our jurisprudence of no right to commit suicide or to be mercifully put away by the medics, “as quick[ly] and painlessly] as possible.”13 There is no natural, constitutional, statutory or court-created right that would permit a person to have the assistance of another person in deliberately taking his own life. I am sure that no one would contend that Mr. Bergstedt had a right to suicidal assistance if he had not been incapable of doing the deed himself. So this brings us to the point, discussed above, that Mr. Bergstedt has been given the court-decreed right to assisted suicide only because he was disabled to the extent described. Such a decree should not have been entered.
I would reverse the judgment of the trial court; first, on the ground that the district court was without jurisdiction to decide an uncontested, one-sided test case and thereafter enter the subject decree; and second, on the ground that, there being no right vested in anyone to be put to death by another, the district court had no power to disregard the law of homicide and decree the legality of assisted suicide in this “case.”

 Black’s Law Dictionary 195 (5th ed. 1979).

 City of North Las Vegas v. Cluff, 85 Nev. 200, 201, 452 P.2d 461, 462 (1969).

 “Suicide” may at first seem like a harsh word to be using under these circumstances, but it is a necessary word and a word that cannot be avoided. The majority defines suicide as the “taking of one’s own life voluntarily and intentionally.” Mr. Bergstedt breathed for twenty-three years with mechanical assistance. Taking away the ventilator was taking away his life — a life that would have gone on indefinitely had he not made the conscious decision to take it away.

 The Bouvia case cited in the majority opinion came very close to outright judicial approval of suicide by a suffering but nonterminal, bedridden patient. One of the three justices of the California Court of Appeal who decided the Bouvia case candidly took the position that some undefined types of persons should be granted by the courts the right to commit suicide, abetted by the kind help of medical personnel who would kill the person in a manner that was as “quick and painless as possible.” But what about the state’s criminal law forbidding the aiding and abetting of suicide? This law was, according to Justice Compton, “archaic and inhumane,” and apparently, to be ignored by the court. Although I disagree with Justice Compton’s position (I think it is the legislature’s business to change the statutory law of homicide if it is going to be changed.), I think the justice was correct in pointing out in Bouvia that in permitting a suffering paralytic to be starved to death at her own request, the majority justices did not come to grips with the suicidal nature of Elizabeth Bouvia’s quite understandable death wish. As Justice Compton correctly declared: “Even the majority opinion here must necessarily ‘dance’ around the issue [of suicide].” I respectfully suggest that the majority is dancing around the issue in this case.

 New York v. Harris, 110 S.Ct. 1640, 1649 (1990) (Marshall, J., dissenting).

 This quote is taken from the amicus curiae brief written by Thomas J. Marzen, general counsel for the National Legal Center for the Medically Dependent and Disabled. Although his brief was rejected by the court because of its late filing, I refer to it in this dissent because it is the only argument to be found in this case that favors life instead of death. Mr. Marzen represents “a national organization of disabled individuals, with some 3000 active members,” some of whom “depend on ventilators to breathe.”

 Olmstead v. United States, 227 U.S. 438 (1928) (Brandeis, J.).

 Marzen, p. 1.

 Marzen, p. 11.

 Stradley, Elizabeth Bouvia v. Riverside Hospital; Suicide, Euthanasia, Murder: The Line Blurs, 15 Golden Gate Univ. L. Rev. 407, 424 (1985).

 [Suicide] is an alternative which can at times be accepted by the individual with advantage to himself, the domestic community and the state. * * *
Briefly, then, I would suggest a court of suicide to which application could be made, and where all proposals would be considered on points *838of equity and with regard to personal and public advantage “in camera,” and without a jury. The applicant would have to satisfy the presiding judge or judges that his removal by death would be the best thing in his circumstances . . ., and that such a course would not be attended by counterbalancing disadvantages to other persons. Upon receiving satisfactory evidence on these points the court would be empowered to grant the applicant a suicide license, authorizing him to take his own life legally, and without prejudice, at the place and time named therein, and (as in the case of a marriage license) at any time within three months of the date thereon, due notice first being given to one of the court’s properly authorized medical practitioners.
“A Modest Defence of Suicide,” The Green Bag, Volume XI, The Boston Book Company (1899).

 Marzen, p. 8.

 See footnote 4, supra.