The court found that the "right to refuse medical treatment is basic and fundamental," and is "recognized as a part of the right to privacy protected by boththe state and federal constitutions. . . .  its exercise requires no one's approval. . . . "  even if the patient is neither terminally ill or imminently dying.  (It was estimated that Bouvia could be sustained by feeding tube for up to twenty years).

The court rejected a request filed by Dr. Daniel Thor, prison physician who wanted approval to implant a gastrostomy tube in Andrews's stomach so that he could be fed against his will.   The court ruled that "a competent, informed adult has a fundamental right of self-determination to refuse or demand the withdrawal of medical treatment of any form irrespective of the personal consequences."

Although competent adults (e.g., Bouvia and Andrews) and permanently unconscious adults (e.g., Drabick) have the right to refuse medical treatment (even if such refusal would cause death), life-sustaining treatment may not be withdrawn from patients who are not (1) terminally ill, (2) comatose, or (3) in a persistent vegetative state unless the "clear and convincing evidence" standard can be met.  One way (but perhaps not the only way) to meet this standard would be for the patient to have either (1) left  formal instructions about medical treatment preferences,or (2) appointed a health care agent or surrogate.  The court ruled that Rose Wendland had not met the clear and convincing evidence standard and denied her request that tube feeding be withdrawn from her husband.