If you were comatose and had been dependent on your family...

Coping/Mortal Matters

October 21, 1991|By Sara Engram | Sara Engram,Universal Press Syndicate

If you were comatose and had been dependent on your family since suffering brain damage in childhood, would you trust them to make decisions about your medical treatment -- or a group of people you'd never met?

Most of us, I think, would readily choose our families -- and, fortunately, our families' right to have their choices take precedence over the wishes of strangers was recently upheld by a state Supreme Court in another important right-to-die case.

In September, Indiana's highest court affirmed the right of the Lawrance family to discontinue tube feeding for their daughter Sue Ann. The family's decision had been challenged by a religious advocacy group for the disabled, who saw the decision an attempt to willfully starve their daughter to death.

The ruling came two months after Sue Ann Lawrance died in July at the age of 42. She had been kept alive by feeding tubes since 1987, but her problems began in childhood. At nine, she underwent a craniotomy to relieve pressure on her brain, but was left with permanent brain damage, balancing problems and, eventually, seizures. Her parents and four siblings lovingly cared for her for many years, but, in 1987, she suffered a fall, underwent another craniotomy and slipped into a persistent vegetative state.

The Supreme Court's ruling noted that the Lawrances would not have needed court permission to discontinue the tube feeding -- which the United States Supreme Court's ruling in the Cruzan case clearly classifies as medical treatment that patients have a right to refuse. But last March the family had asked court permission anyway. When permission was granted, they moved Sue Ann to a hospice, where she would spend her last days.

Then they were faced with an unexpected development. A group called Christian Fellowship with the Disabled petitioned the courts for guardianship of Sue Ann, so that they could appeal the lower court's decision.

In May, the petition was granted, and the family agreed to a 21-day delay so the matter could be reviewed. Daniel Avila, an attorney with the National Legal Center for the Medically Disabled and Dependent, stepped in as Sue Ann's temporary limited guardian and the case went to the state Supreme Court.

Avila's group, which receives federal funds, supports the Right to Life movement and that movement's attempts to classify people in persistent vegetative states or irreversible comas as handicapped or disabled, rather than terminally ill.

The distinction is important. A disabled person may not be deprived of medical treatment. If a persistent vegetative state is considered a disability rather than a terminal condition, then living wills and durable powers of attorney and the rights of families to make surrogate health care decisions are all called into question.

In effect, federal dollars were subsidizing an effort to intervene in decisions which, by Indiana law, belonged to the Lawrance family -- not to strangers who never knew Sue Ann or provided her care.

Any person or group is certainly entitled to believe that withdrawal of tube feeding is, in effect, murder. But that is essentially a religious view, one with which many Americans and most of the medical community would disagree. And since this country was founded on a religious diversity, I suspect most Americans would agree that those beliefs should not be forced on other people who are acting within the law.

Like any society, this country thrives on the close ties that bind its families together. Fortunately, the Indiana court affirmed that, in agonizing life-and-death decisions, family ties take precedence over the religious convictions of strangers.

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