Key point. The civil courts may authorize the withdrawal of life-support systems for a person in a persistent vegetative state under certain conditions.
* A Florida court granted a husband's request to discontinue life-support systems for his wife, who had been in a persistent vegetative state for ten years, despite the objections of her parents. The termination of life-support systems for a family member in a vegetative coma is one of the most difficult decisions that any family can make. Families often turn to their pastor for guidance. Of course, theological and pastoral concerns are paramount in such cases, but since the final decision is made in a legal context it is important for pastors to have some understanding of the legal principles that apply. A recent case in Florida illustrates some of the legal issues. A married couple had a baby daughter in 1963 (Theresa). Theresa lived with her parents until she married Michael in 1984. Michael and Theresa moved to Florida in 1986. They were happily married and both were employed. They had no children. In 1990 their lives changed. Theresa, age 27, suffered a cardiac arrest as a result of a potassium imbalance. Michael called paramedics and Theresa was rushed to the hospital. She never regained consciousness. Since 1990, Theresa has lived in nursing homes with constant care. She is fed and hydrated by tubes. The staff changes her diapers regularly. She has had numerous health problems, but none have been life threatening. The evidence is overwhelming that Theresa is in a permanent or persistent vegetative state. A persistent vegetative state is not simply a coma. She is not asleep. She has cycles of apparent wakefulness and apparent sleep without any cognition or awareness. As she breathes, she often makes moaning sounds. Theresa has severe contractures of her hands, elbows, knees, and feet.
Over the last decade, Theresa's brain has deteriorated because of the lack of oxygen it suffered at the time of the heart attack. By mid 1996, the CAT scans of her brain showed a severely abnormal structure. At this point, much of her cerebral cortex is simply gone and has been replaced by cerebral spinal fluid. Medicine cannot cure this condition. But for a miracle, Theresa will always remain in an unconscious, reflexive state, totally dependent upon others to feed her and care for her most private needs. She could remain in this state for many years. Theresa has two loving parents and a loving husband. Michael has continued to care for her and to visit her all these years. He has never divorced her. Theresa's parents have continued to visit her often. Her parents have prayed for a divine miracle that now is Theresa's only hope to regain any level of normal existence.
In the early 1990s, Michael filed a medical malpractice lawsuit. That case resulted in a sizable award of money for Theresa. This fund remains sufficient to care for Theresa for many years. If she were to die today, her husband would inherit the money. If Michael eventually divorced Theresa in order to have a more normal family life, the fund remaining at the end of Theresa's life would presumably go to her parents. Since the resolution of the malpractice lawsuit, both Michael and Theresa's parents have become suspicious that the other party is assessing Theresa's wishes based upon their own monetary self-interest.
After ten years, Michael asked a court to authorize the removal of life support systems, which of course would result in Theresa's death. Theresa's parents opposed this action. The court granted Michael's request, and authorized the removal of all life-support systems. It concluded,
The testimony in this case establishes that Theresa was very young and very healthy when this tragedy struck. Like many young people without children, she had not prepared a will, much less a living will. She had been raised in the Catholic faith, but did not regularly attend mass or have a religious advisor who could assist the court in weighing her religious attitudes about life-support methods. Her statements to her friends and family about the dying process were few and they were oral. Nevertheless, those statements, along with other evidence about Theresa, gave the trial court a sufficient basis to make this decision for her.
In the final analysis, the difficult question that faced the trial court was whether Theresa, not after a few weeks in a coma, but after ten years in a persistent vegetative state that has robbed her of most of her cerebrum and all but the most instinctive of neurological functions, with no hope of a medical cure but with sufficient money and strength of body to live indefinitely, would choose to continue the constant nursing care and the supporting tubes in hopes that a miracle would somehow recreate her missing brain tissue, or whether she would wish to permit a natural death process to take its course and for her family members and loved ones to be free to continue their lives. After due consideration, we conclude that the trial judge had clear and convincing evidence to answer this question as he did.
Application. While polls indicate that the vast majority of Americans would not want their lives prolonged artificially if they became permanently unconscious or comatose, very few have executed "living wills" or left other reliable written evidence of their desires that could guide family members in making the difficult decision that haunted Theresa's husband and parents. A "living will" is a legal document that permits a competent adult to request that his or her life not be prolonged by artificial means under specified circumstances. Such documents are recognized by law in most states. In many states, living wills are quite restrictive—authorizing the termination of artificial life-prolonging procedures only in the event that the individual is mentally incapacitated and facing imminent death from a terminal disease from which there is no reasonable hope of recovery. Other states are more liberal and allow for the termination of life-support for persons, such as Theresa, who are facing imminent death. Many state laws specify the form and content of living wills. It is essential that persons who do not want their lives prolonged by artificial means review the living will prescribed by state law, and determine whether or not it accurately reflects their desires. The assistance of an attorney is recommended in preparing any legal document, but particularly one that is not in the precise format prescribed by state law.
No one, other than medical personnel themselves, are more familiar with deathbed vigils and comatose and incompetent patients than clergy. They often see firsthand the anguish experienced by family members in making decisions affecting the life of a loved one. How often such family members long for the comfort and guidance of clear, written instructions from the patient. But such comfort is seldom available, since so few persons take the time to express their desires in an effective document. Clergy can be instrumental in preventing this heartache. They are respected by their parishioners, and their counsel is valued perhaps more than that of any other individual. Regardless of a person's desires—whether or not to artificially prolong permanently unconscious life—clergy should encourage church members to put their desires in a legally recognized form (a living will or otherwise), being as specific as possible. Not only will this provide assurance and comfort to family members making the critical decision whether or not to artificially prolong life, but it also will ensure that the state itself will honor those wishes. In re Guardianship of Schiavo v. Schiavo, 2001 WL 1230544 (Fla. App. 2001).
© Copyright 2002 by Church Law & Tax Report. All rights reserved. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is provided with the understanding that the publisher is not engaged in rendering legal, accounting, or other professional service. If legal advice or other expert assistance is required, the services of a competent professional person should be sought. Church Law & Tax Report, PO Box 1098, Matthews, NC 28106. Reference Code: m44 c0102