(2 of 2)
The legal problems involved in allowing elderly patients to die have created a dilemma for physicians and hospitals, even when the wishes of patients or their families are clear. For instance, doctors at Good Samaritan Medical Center in Phoenix last week insisted that a court order be obtained before they would comply with an 83-year-old woman's wish to be disconnected from the respirator that was keeping her alive and in pain. Nearly three years earlier, the woman had drawn up a "living will," a document that requested hospitals not to prolong her life by extraordinary measures. Because Arizona does not recognize such a will (15 states and the District of Columbia do), doctors did not want to take legal responsibility for her death.
There is good reason for caution. In 1982 two physicians in California were charged with murder for complying with a family's request to remove feeding tubes from a hopelessly brain-damaged patient. The charge was dismissed upon appeal last fall. But, together with similar cases around the country, it has "sent a chill into the medical community," according to Washington Gerontologist Joanne Lynn, principal author of a 1983 Presidential Commission report on medical ethics.
Fear of legal reprisal has apparently led some hospitals to conceal decisions on life support so that no one can be held responsible for deciding to pull the plug. A New York grand-jury report last month charged administrators at a Queens hospital, widely recognized as La Guardia, with "shocking procedural abuses" in the care of elderly patients. According to New York State Prosecutor Edward Kuriansky, the hospital would put purple decals on the charts of patients who were not to be resuscitated should they start to fail. After death, the charts were destroyed so that there was no record of the fatal decision. La Guardia officials deny the charge, but there is no doubt that a number of American hospitals lack clear procedures for observing and recording the wishes of dying patients. Says Dr. S. David Pomrinse, recently retired president of the Greater New York Hospital Association: "In hospitals that have no rules, in the middle of the night you have a poor 21-year-old nurse trying to decide whether or not to call in the resuscitation team."
Because of the attention such cases have received in the past few years, many hospitals and states have begun to set guidelines so that life-and-death decisions are not made rashly in the heat of the night. By playing the gadfly, Governor Lamm may have promoted further discussion, and clarification, of a troubling ethical issue.