In a case that medical ethicists and legal experts say is apparently a first, a Minneapolis hospital plans to go to court for permission to turn off a patient's life support system against her family's wishes.
For eight months, 87-year-old Helga Wanglie has lain in Hennepin County Medical Center in a world created by modern medicine: dependent on a ventilator for oxygen and a feeding tube for nutrition, unaware of and unresponsive to her surroundings.
Her doctors say she will never recover, and they do not want to give care that they describe as futile.
But Mrs. Wanglie's husband and two children describe her as an extremely religious woman who would prefer even this life to death.
"This is the opposite of Cruzan," said Arthur Caplan, director of the Center for Biomedical Ethics at the University of Minnesota, referring to Nancy Cruzan, the Missouri woman whose family fought for years to remove her from the feeding tube that was keeping her alive.
Over the objections of the state hospital where Miss Cruzan lived in a vegetative coma, the tube was removed and she died last month.
"We've all worked long and hard for the patient's right to say stop," said Susan M. Wolf, an associate for law at the Hastings Center, a research center for biomedical ethics in Briarcliff, N.Y.
"That leaves the lurking question of whether it's a symmetrical issue and they also have the right to say do everything indefinitely, even when the doctors believe it's futile."
It is a rare termination-of-care case of any kind that reaches the courtroom. Decisions to withdraw medical technology are made daily around the country. The American Hospital Association estimates that 70 percent of hospital deaths are preceded by a decision to stop some form of care.
Yet Mr. Caplan said he knew of no more than 40 state court opinions about the termination of care.
It is even rarer that a dispute finds the doctors arguing for withdrawal of life support against the wishes of the patient's family. "None of those 40 address that situation," he said.
Dr. Eugene Boisaubin, an emergency room doctor who is head of the biomedical ethics consultation service at the Methodist Hospital in Houston, said circumstances similar to those of the Wanglie family arise regularly. He estimates that 95 percent of the disagreements can be resolved with talking and time.
In the other 5 percent of cases, he said, "we do what the family wants, even though it goes against our medical judgment. . . . Until this, no one had the guts to go to court."
On Dec. 14, 1989, Mrs. Wanglie tripped on a scatter rug and fractured her right hip. She underwent surgery at a private hospital near her home. The next month she developed breathing problems and was transferred to the Hennepin County Medical Center, where she was placed on a respirator.
She stayed there for five months, fully conscious and alert.
In May she was weaned from her respirator and transferred to a long-term care institution across the river in St. Paul. She had been in the institution for less than a week when her heartbeat and breathing stopped.
By the time she could be resuscitated, she had suffered severe brain damage. She was transferred back to Hennepin County Medical Center in a persistent vegetative state.
"She doesn't know anybody or anything," said Mr. Wanglie, 86, a retired Minneapolis lawyer. He and his children, Ruth, 48, and David, 45, visit two or three times a week, he said. They stay about a half-hour and talk to the nurses about Mrs. Wanglie's condition, but they do not talk to his wife, he said, because "she wouldn't even know we were there."
"She told me, 'Only He who gave life has the right to take life,' " Mr. Wanglie said of a discussion he had with his wife before her fall. "I take the position that as long as her heart is beating, there's life there."
Dr. Michael B. Belzer, medical director of Hennepin County Medical Center, said that he sympathized with the Wanglies but that a heartbeat no longer signified life. Machinery can keep a patient's heart beating long after there is any hope of recovery, he said.
The case illustrates a broader debate over when medical care becomes futile. The most broad interpretation is that care is futile if it will not cure the underlying condition or make the patient more comfortable.
Mrs. Wanglie's case is unusual because her family's health insurance covers her hospitalization almost entirely.
"This is a pure ethics case," Mr. Caplan said. "It's not about money but futility and what we mean by futility. We've talked around that concept in recent years, using the smoke screen of 'Can we afford to do this?' There's been a harder question buried under that layer of blather about money, namely, 'What's the point of medical care?' "