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by Wesley J. Smith

December 8, 1995

"Robert  [Wendland] will need to learn to adjust to no stimulation," reads the sign above the cognitively and physically disabled man's bed at Lodi Memorial Hospital West. This means that for much of the time, Robert lies in bed, without lights, music or television. He may only have visitors for 1 1/2 hour per day.

This is a sea change in Robert's care. After 16 months in a coma caused by injuries received in an auto accident, Robert woke up and, until recently, was receiving physical and speech therapy to rehabilitate him. Robert appeared to be slowly improving. Indeed, he progressed so far in less than a year that he can maneuver himself in a motorized wheel chair through hospital corridors.

It is claimed by Robert's doctor, that the recent change in Robert's care is required by a problem with his blood sugar. But it may not be coincidental that Robert's activities have been diminished just as a court battle rages over his right to live. You see, Robert is the subject of a bitter controversy. His wife, Rose Wendland, wants to cut off the "medical treatment" of food and fluids provided through a tube. In fact, Robert would be dead now but for his mother and sister, Florence Wendland and Rebekah Vinson, fighting to keep him alive. Despite the fact that Robert is conscious and interactive, Rose's decision to cause Robert's death is supported unanimously by the Lodi Memorial Hospital ethics committee. However, a close look at the committee's approval reveals some disturbing facts. As far as is known, no one argued on behalf of saving Robert's life. The nurses and therapists, the very people who spend the most time with Robert, were never asked to appear before the committee. (Several were upset with the decision.) Indeed, the ombudsman, whose specific job is to advocate on Robert's behalf, wasn't even aware that Robert was able to manipulate a motorized wheel chair, when she too decided to support Rose's plans.

Wait, there's more. Right after Robert's mother and sister received an anonymous tip and decided to go to court to save his life, Robert was moved from a ward where he was known by staff who truly care about him, to another, where he would be cared for by strangers. The reason given, according to court testimony, was that Robert's initial caregivers were getting too involved with his case. But disability rights activists say that one way to make cognitively- disabled persons regress, and therefore appear less conscious, is to make them depressed. One way to depress such disabled persons is to remove them from a familiar environment, which is essential to their cognitive improvement.

As if that weren't disturbing enough, it now appears that Robert may have received inadequate medical care. Board certified neurologist and psychiatrist Vincent Fortanase, who has looked into Robert's case on behalf of Robert's mother and sister, has found disturbing facts from a review of Robert's medical records and discussions with his doctors and other care givers. For example, even though Robert has been awake almost a year, an electroencephalogram (EEG), which can help diagnose problems in the brain, has not been performed. Moreover, Dr. Fortanase determined that Robert may be having seizures. Yet, he has never received neuropsychological testing, important along with the EEG, because patients with seizures often respond to medication. Given appropriate treatment, Robert might obtain a higher level of interactive capability.

Dr. Fortanase recommends that Robert be transferred to a rehabilitation center that, unlike Lodi Memorial Hospital, specializes in treating brain-injured patients. There, he would be able to receive the diagnostic and specialized care he so obviously needs.

If that is to happen, it may not be soon. At Rose's request, the hearing to determine Robert's fate was just delayed from December 18, to March 4, 1996.

Robert's case is not unique. In Florida, the brother of 83 year-old stroke patient Marjorie Nighbert, decided to cut off her tube feeding, allegedly because of the terms contained in her advanced directive. Marjorie was not unconscious. During her starvation, she specifically asked nurses for food. This was so upsetting to one nurse that she blew the whistle. Enter the court, where, after a hurried investigation, it was determined that Marjorie was not medically competent to retract her advanced directive (in other words, to ask for the "treatment" of food). Thus, even though she had asked to be fed, the starvation was allowed to continue. Ms. Nighbert died on April 5, 1995.

All over the country, in hospitals, nursing homes, and other facilities, conscious but cognitively disabled and aged people are being denied adequate care and/or are being starved and dehydrated to death in the name of patient autonomy, "quality of life", and "best interests of the patient" determinations. But what is really going on is the creation of a disposable caste of people, whom we, the healthy, find too emotionally painful, too expensive or too inconvenient to care for, and whose intentional killing we increasingly find all too easy to rationalize.