Fonseca v. Smith

Ninth Circuit Court of Appeals (2020)

At a Glance:

Compassion & Choices filed an amicus brief in a California lawsuit, Fonseca v. Smith, defending California’s legal definition of brain death—the irreversible cessation of all functions of the entire brain, including the brain stem—as death. Opponents filed the suit seeking to undermine California’s legal definition of brain death after a California hospital decided to stop artificial life support for a brain-dead boy. In September 2020, the United States Court of Appeals for the Ninth Circuit affirmed the lower court’s dismissal of the lawsuit, preserving California’s definition of brain death as death.

The Details:

In October 2017, the mother of a deceased boy and the Life Legal Defense Fund, a group opposed to medical aid in dying and reproductive rights, filed a federal lawsuit challenging California’s legal definition of brain death as death after the Children’s Hospital of Los Angeles decided to remove a brain-dead boy from life support. In April 2016, the child suffered a severe asthma attack that left him brain dead—a diagnosis confirmed by physicians at two different California hospitals. Plaintiffs claimed the Director of California’s Department of Public Health and Safety, Karen Smith, M.D., should have prevented the hospital from discontinuing the boy’s artificial life support in August 2016, even though a state court order declared he was legally dead and his artificial life support should end.

Compassion & Choices, with the assistance of Jon Eisenberg and Hanson Bridgett LLP, submitted an amicus brief in May 2018, urging the Ninth Circuit to uphold the lower court’s dismissal. Their brief argued: “The modern consensus that brain death is actual death derived from years of painstaking study and recommendations by dedicated medical and legal researchers … with joint support from the American Medical Association, the American Bar Association and the National Conference of Commissioners on Uniform State Laws.” The brief argued the definition was necessary due to medical advances in technology that can sustain a heartbeat and respiratory function long after a person’s brain function has completely ceased.

In September 2020, the Ninth Circuit released an unpublished opinion upholding the lower court’s conclusion that Plaintiffs lack legal standing to maintain their challenge to California’s Uniform Determination of Death Act (CUDDA), which defines death to include brain death. The Ninth Circuit stated in its opinion, “California has defined brain death as ‘death’ since 1974…eight years before CUDDA was adopted in 1982. Thus, doctors may make exactly the same medical decisions regarding the definition of death without CUDDA.” Plaintiffs did not appeal the Ninth Circuit’s ruling, which remains good law.

The ruling in Fonseca is consistent with medical science and ensures that those who are dead will not be kept artificially alive through futile care. Compassion & Choices continues to fight in the courts to ensure that all individuals receive compassionate and respectful care at the end of life.

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VICTORY: Colorado Gov. Jared Polis signed the improved End-of-Life Options Act.

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