By Liz Townsend
Editor’s note. Over at “EPC applauds precedent-setting Rasouli decision by the Supreme Court of Canada,” we talk about the court’s wise decision not to allow physicians in Canada to unilaterally decide whether someone can be starved and dehydrated to death. NRL News has, alas, written about many cases (most famously Terri Schiavo) where the patient was denied food and fluids. This story from the October 12, 1998, edition of National Right to Life News is our contribution today to the “Roe at 40” series where we are bringing you some of the most important stories from NRL News going all the way back to 1973.
After starving and dehydrating for eight days, a severely disabled man died October 9 in a Virginia nursing home, ending a long court struggle between his wife, who wanted his feeding tube removed, and other members of his family who vigorously disagreed. Hugh Finn’s feeding tube, which provided the nutrition and hydration needed to keep him alive, was withdrawn October 1 despite the objections of his parents, mother-in-law, and others.
Without food or fluids, patients begin to slowly dehydrate, causing their faces to become extremely thin and their eyes to become dry and bloodshot, doctors told the Washington Post. Their bodies soon begin to shut down completely, with blood volume dropping, hands and feet getting colder as less blood flows through the body, and the kidneys failing.
Once the kidneys fail, waste products build up in the bodies leading to the threat of infection. The patients then usually lapse into a coma, possibly suffering seizures, and then their hearts stop and they die.
Finn died at 10:10 a.m. October 9 from cardiopulmonary failure.
Finn’s parents, Thomas and Joan, and Hugh Finn’s mother-in-law prayed with about 200 others in a vigil October 4 outside the nursing home while their son lay dying. Finn’s mother told the Post that there was no way for them to stop their son’s death. “We had run out of avenues and options. We still feel we don’t want this to happen to Hugh,” Joan Finn said. “We reached the end of things that we could do. I just don’t think that he should be put to death. Tom and I are willing to take care of him.”
A firestorm of controversy erupted in Virginia when relatives of Hugh Finn, 44, tried to stop the removal of his feeding tube. Finn had been diagnosed as being in a persistent vegetative state (PVS) since a car crash on March 9, 1995, near his home in Louisville, Kentucky. Although doctors were able to save his life, his brain was deprived of oxygen after his aorta (the vessel carrying blood from the heart to the rest of the body) ruptured, according to the Post.
Michele Finn moved her husband to the Annaburg Manor nursing home in Manassas, Virginia, in February 1996, so he could be near his parents and siblings. Mrs. Finn and her two daughters remained in Louisville.
In June 1998, Mrs. Finn decided to withdraw her husband’s feeding tube after doctors told her there would probably be no improvement in his condition, the Post reported, Judge Hoss heard arguments in July and ruled on August 31 that Finn’s feeding tube could be removed in 21 days.
There was no direct evidence of Finn’s wishes. Hoss said in his decision that testimony from Michele Finn and Finn’s lawyer provided “clear and convincing evidence” that Finn “would not wish to have his life artificially prolonged,” according to the Post.
“What is the big rush to put him to death? What if down the line there’s an advance in medical science?” Thomas Finn told the Post. “It’s murder as far as I’m concerned.”
Although several doctors diagnosed Finn as being in a PVS, others claimed he showed some indications he was aware of his environment. “I see bits of his personality, the way his features get ruffled, the way he looks at you,” Finn’s brother Edward told the Post.
Just three days before the tube was to be removed, nurse Marie F. Saul from the state Department of Medical Assistance Services visited Finn to investigate his condition, the Post reported. According to an affidavit filed with the court by Virginia Attorney General Mark Earley’s office, Finn said “hi” to Saul when she entered his room and “mumbled what appeared to be words.” In response to the affidavit, on September 21 Judge Hoss postponed the tube removal and gave the family nine days to appeal his ruling.
Family members announced September 28 that they had decided not to appeal the ruling to the state Supreme Court. Although initial reports indicated that all of Finn’s family agreed to stop fighting, the Washington Post later reported that Michele Finn’s sister asked Virginia Gov. James Gilmore to step into the case. Other family members also came forward and continued to protest the feeding tube removal.
Gilmore filed an appeal October 1. “My job as governor and my role is to protect those people who are most frail in society and cannot necessarily protect themselves,” said Gilmore, according to the Post. Gilmore said he holds “a longstanding belief that people who are in these types of frail medical conditions ought to have the best possible review of their cases by the courts. I’ve felt always very strongly about that.”
The state Supreme Court rejected Gilmore’s appeal October 2, ruling that state law allows the removal of a feeding tube from a patient in Finn’s condition. In a three-paragraph decision, the court wrote that the withdrawal of food and water “merely permits the natural process of dying.”
Virginia law authorizes guardians or doctors to remove nutrition and hydration from patients with terminal illnesses or those in a PVS, “from which, to a reasonable degree of medical probability, there can be no recovery.”
“Unfortunately, cases like this are not rare anymore,” said Thomas Marzen, general counsel of the National Legal Center for the Medically Dependent and Disabled. “It is virtually standard medical practice to withhold tube feeding from PVS patients. Virginia is merely more explicit in specifically allowing the withdrawal of food and water from these patients.”
In addition, the law allows doctors to withdraw a feeding tube even if the entire family disagrees with the decision — and even if the patient had asked to be kept alive. The statute explicitly legalized the involuntary denial of treatment when a doctor thinks that following a patient’s expressed desire for life would be “medically or ethically inappropriate.”
During debate in the legislature, an amendment was proposed to protect such a patient’s life pending transfer to a facility willing to honor the patient’s or family’s choice for life, but it was defeated.
“Every American has reason to fear for family members when a disabled person can be starved and dehydrated to death based on a perceived lack of `quality of life’ without the consent of the patient or even of the family,” said David N. O’Steen, Ph.D., NRLC executive director. “Laws such as Virginia’s, which are in effect in states across the country, threaten the most vulnerable in our society, who deserve protection and assistance, not death.”
One way to help protect against what happened to Hugh Finn is to make sure all family members have a “Will to Live,” a legal document that names someone to make health care decisions for them and makes clear what medical treatment they would want if they can no longer speak. Without an explicit, written statement asserting that the patient wants to continue to receive food and water, many doctors and hospitals will assume a disabled person’s “quality of life” is so low that nutrition and hydration should be withdrawn.
“Two things are evident if we wish to save our own lives and those of our families,” said O’Steen. “First, we must individually sign Wills to Live to protect ourselves from the now commonplace nonvoluntary denial of treatment, food, and fluids to those who have never made their preferences clear.
“Second, we must collectively press, at a minimum, for legislation that will protect people from involuntary denial of treatment, food, and fluids despite their Wills to Live. The time to act is now,” he said.
NRLC has prepared sample Wills to Live that correspond to the laws of each state. You can read these at www.nrlc.org/medethics/willtolive/