August 10, 1998 Vol. 6, #6
Lack Of Advance Directive Contributes To Family TragedyIn 1993, Robert Wendland suffered a terrible automobile accident. The California man never recovered sufficiently to communicate, and he was unable to participate in the controversy over the possibility of removing his feeding tube last winter.
Wendland, brain-damaged and paralyzed, lived for two years on a feeding tube threaded through his nose and into his stomach before his wife of fifteen years asked the California courts for permission to disconnect his feeding tube.
Wendland's wife Rose insisted that he had told her before his accident that he would not want to be kept a live in a condition of total dependence. Wendland's physicians testified that he would never recover significantly, and that his ability to think may have been impaired by the accident. They also explained that Wendland could not (or would not) interact with his environment, and that he made no attempts of his own to communicate with family, caregivers or health care providers.
Before asking the court's permission to disconnect Wendland's feeding tube, his wife referred the case to the ethics committee at Lodi Memorial Hospital West, where Wendland was being treated. The ethics committee, the treating physician, Mrs. Wendland, the couple's children, and even Wendland's brother all agreed that the tube should be disconnected, and Wendland should be allowed to die.
When Mrs. Wendland made her request to disconnect the tubes, however, Wendland's mother and sister objected. They filed a court proceeding, in which they argued that Wendland should be kept alive and not "starved or dehydrated to death." The court battle took nearly two years to resolve.
Last December, San Joaquin County judge Bob McNatt agreed with Wendland's mother and sister. Saying that the case was a tough call, and that he was likely to experience sleepless nights himself, the judge ruled that "if I have to choose life and death based on the evidence presented to me, I must err on the side of caution and choose life." The judge even went so far as to acknowledge that "it's unknown whether I'm preserving Robert's life or I am sentencing him to life."
Robert Wendland's story is tragic, of course. Beyond the human suffering occasioned by his injury and extended treatment, there is the family anguish associated with disagreements about what he would want. Although his wife insists that he did tell her his wishes, her word was ultimately not enough to permit the treatment choice she is sure he would have made.
The Wendland family tragedy is similar to a case arising from a Southern Arizona family's disagreement three months ago. Mae Belle Owens had executed a living will and health care power of attorney, but had not shared their contents with all of her ten children. When the daughter named in the documents sought to use the power of attorney to ensure that Ms. Owens died at home, another daughter intervened, insisting that her mother would have wanted to be treated. Ms. Owens died in a Sierra Vista nursing home last February.
Most people believe that, by signing living wills and health care powers of attorney they have done all that is necessary to ensure that they do not receive unwanted medical treatment. Many others, like Robert Wendland, believe that they can take care of the problem by simply telling a spouse, child, family member or friend what their wishes would be. The tragic reality is that neither course of action is sufficient. It is critically important that documents be signed in advance, and that the contents of those documents be shared with family members, health care providers and others involved in the patient's life. Wide distribution of the documents dramatically increases the likelihood that treatment decisions will be honored.
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