California
right-to-die case offers new test
Man's mother battles wife over halting treatment
By Karen Brandon, Tribune staff
reporter. Tribune staff reporter V. Dion Haynes and Tribune news services
June 4, 2001
SAN DIEGO -- A
right-to-die case before the California Supreme Court has the potential to
influence the debate over when life-sustaining treatment of profoundly
brain-damaged people may be ended.
The case of Robert Wendland is carrying the
debate over the right to die into new territory because Wendland is neither in a
coma nor in a persistent vegetative state, which is defined as having no
awareness of one's surroundings, even though the patient may look alert.
Doctors have testified that Wendland, 49, a
former salesman from Stockton, Calif., who was severely injured in a 1993
traffic accident in which he was driving while intoxicated, never will be able
to feed himself, bathe himself, control his bladder or bowels or communicate
orally or in writing.
For six years, family members have been arguing
in the state court system over whether to continue to offer him food and water
through tubes.
His wife, Rose, and their three children want to
withdraw the tubes, saying Wendland said he would not want to live in this way.
Her husband, Rose Wendland has said, died the day of his accident.
But Robert Wendland's mother, Florence, along
with his half-sister, are fighting for his life. Florence Wendland has said she
would battle to the U.S. Supreme Court to keep him alive. At the original trial,
a judge sided with Florence Wendland but was reversed by the state appeals
court. The state high court is expected to rule this summer.
Questions raised
The case raises questions about who should make
the decision, and whether Wendland's expressed wishes before his accident apply
now. He is said to have told family members that he did not want to live
"like a vegetable," a description that his mother argues does not
describe his condition.
"Dying has become as much a decision as an
inevitability," said Paul Root Wolpe, a medical ethicist at the University
of Pennsylvania Center for Bioethics in Philadelphia. "The fact that we
have developed technology to draw that decision out further has bestowed upon us
a responsibility to decide when that technological intervention is
inappropriate."
This case is distinct from previous landmark
cases on the subject.
Karen Quinlan, a New Jersey woman who fell into
a coma in 1975 apparently after mixing alcohol and a tranquilizer, became a
symbol of the issue in 1976 when her parents successfully sought to remove a
respirator. She died nine years after its removal.
In 1990, the U.S. Supreme Court allowed the
family of Nancy Cruzan, a Missouri woman who had been in a persistent vegetative
state after a car accident, to remove artificial feeding tubes against the
state's wishes. She died later that year.
"Now we get to these cases that are
somewhat more complicated," Wolpe said.
Rose Wendland's attorney, Lawrence Nelson, said
she ought to be able to act on her husband's wishes. If his opponents prevail,
he said, people will have to predict every medical calamity that may befall them
in order to leave instructions specific enough to avoid a case like Robert
Wendland's.
"If the largest state in the country adopts
a standard, thousand of Californians will be tethered and stapled and stuck on
life support because they didn't predict the future," Nelson said.
Different views
Robert Wendland's condition has been the subject
of much disagreement.
Florence Wendland has said that her son can
operate an electric wheelchair, write the first letter of his first name, kiss
her hand and offer his own hand to be kissed. He can bowl and was once named
"Bowler of the Year" at the acute care facility where he lives in
Lodi.
The picture presented by Rose Wendland and
doctors is starkly different.
Experts have acknowledged that Robert Wendland
has cognitive behavior that they compared to "a trained response where an
animal or child is trained on a primitive level."
`Rote response'
"Robert is unable to think in the manner we
conceive humans do, and his responses are simply a matter of rote
response," a court summary of Rose Wendland's experts said.
Three months before Robert Wendland's accident,
his father-in-law died after his life-support machine was turned off at the
family's request.
Rose Wendland has said that her husband assured
her that the family made the right choice. She testified, "He told me at
that point I would never want to live like that, and I wouldn't want my children
to see me like that."
She and their three children visited him daily
for 16 months while he was in a coma. Rose Wendland said she delayed acting on
her husband's wishes because she hoped for a recovery.
But in the summer of 1995, after his feeding and
hydration tubes had to be surgically reinserted four times, she reached her
decision.
Though the hospital's ethics committee did not
object to her wishes, Florence Wendland, who was estranged from her son for many
years, received an anonymous telephone call about the plans and objected.
Question of ambivalence
Florence Wendland has argued that her son does
not want to die and points to a session he had with a doctor four years ago in
responding to a series of questions by pushing or pointing to bars designating
"yes" or "no."
"Do you have pain?" the doctor asked.
"Yes."
"Do you want us to leave you alone?"
"Yes."
"Do you want more therapy?"
"No."
"Do you want to die?" No answer.
In a hearing last week, one justice said that
the lack of an answer to the last question indicated ambivalence.
Medical ethicists say it is impossible to know
what the man meant.
"Here's the court having to make a decision
on very scanty evidence," Wolpe said. "Does his inability or
unwillingness to answer that question, if he understood it, mean he has
ambivalence? I don't know."