Eating his words - withholding fluids from the cognitively disabled

National Review, Dec 11, 1995 by Wesley J. Smith

ONE morning two years ago, Robert Wendland, age 42, came home from an all-night drunk. He was confronted by his wife Rose, and his brother Mike. An argument ensued. Rose told him that if he continued drinking and driving, he would end up dead, would kill someone else, or spend the rest of his life in a hospital, and the family would all have to suffer for it.

Robert replied that if such a thing happened, if he could not live as a full man, he wanted to die.

One week later, Rose's worst fears came to pass. After a terrible auto accident, Robert was in a coma.

Robert remained unconscious for 16 months. Then, last January, he unexpectedly began to wake up. According to court testimony by his nurses and therapists, confirmed by the medical records, Robert has since learned to maneuver a motorized wheel chair on command, avoid obstacles, and has even wheeled himself outside the hospital. He responds to requests, such as "Hand me the ball," between 80 to 100 per cent of the time. He can retrieve and return colored pegs from a tray, when asked to do so by a therapist, evidencing sophisticated neurological function. He knows people when they come into the room. He can now support up to 100 pounds on one of his legs, which means his muscle tone is returning. He shows emotional responses to his environment. For example, he has reached out and kissed his mother's hand.

True, he cannot communicate well, and he remains profoundly disabled. But, according to the therapists, he has been steadily, if slowly, improving since awakening.

In early July, Rose approved an intensified regimen of therapy for Robert. Two weeks later, his feeding tube came out of his abdomen. Unexpectedly, Rose decided not to have the tube replaced. Robert would no longer receive food and fluids. In other words, Robert was to be starved and dehydrated to death.

A temporary naso-gastric tube was placed in Robert for feeding, while Rose and the doctor in charge of the case, lung specialist Dr. Ronald Allen Kass, brought the matter to the hospital ethics committee seeking its imprimatur to let Robert die. The committee unanimously approved the withdrawal of food and fluids, with the additional support of the San Joaquin County Ombudsman, who had been assigned as Robert's patient advocate.

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. They could have told the committee, as they later did a judge, that Robert is cooperating with his therapy, at least an implied statement that he desires to live. Nor were family members, who were later to oppose the dehydration, allowed to appear. Indeed, Robert's sisters and mother were not even told his killing was being contemplated. (Robert's brother Mike, who supports Rose, was aware of her decision.) The ombudsman, whose job is to advocate on Robert's behalf, wasn't even aware that Robert was able to manipulate a motorized wheel chair, when she decided to support Rose's plan.

Had it not been for an anonymous phone call to one of Robert's sisters, he would be dead now. But the phone call was made, and as a consequence, Robert's mother, Florence Wendland, and his sister, Rebekah Vinson, obtained a restraining order preventing Robert's dehydration. Now, a divided family has squared off in court. On December 18 1995, Judge Robert W. McNath will decide whether Rose will be empowered to continue to make Robert's medical decisions and if so, whether she will be permitted to order Robert's food and fluids withheld.

'This is stealth euthanasia," says Dr. William J. Burke, Professor of Neurology at St. Louis University. "The deaths of these patients are a dire warning about the increasingly perilous state of our medical ethics."

The patients about whom Dr. Burke speaks, like Robert Wendland, are the cognitively disabled men, women and children whose nutrition and water, supplied by feeding tube, is almost routinely being cut off in hospitals and nursing homes around the country. The intentional killing of these patients, most of whom are quietly dehydrated behind closed doors because no one objects, began with those diagnosed as permanently unconscious. In a classic application of the slippery slope, it has now spread to the disabled who are without doubt conscious and interactive.

These pages previously have chronicled attempts to starve cognitively disabled but conscious people to death. In Vermont, there was the case of Ronald Comeau, a drifter whose court-appointed guardian got a probate court to agree to withholding Comeau's food and fluids based on "quality of life" considerations. His life was saved because a local minister found Comeau's relatives, who called off the killing. ("The Right to Die, The Power to Kill," NR, April 4, 1994).

Then there was the Michael Martin case. Mr. Martin was conscious and interactive and appeared content with his life. Despite this, a trial judge and the Michigan Court of Appeals ruled that he could be dehydrated to death. ("Better Dead than Fed?" NR, June 27, 1994). The Supreme Court of Michigan saved Martin's life, but not because they ruled that it is wrong to dehydrate a conscious, interactive human being. Rather, they determined that there was insufficient evidence that Martin had expressed a desire to die if ever in his current condition.