Hugh Finn died on October 9, 1998, after starving and dehydrating for eight days without a feeding tube. His wife Michele Finn asked for the tube removal in June 1998, three years after Finn was severely injured in a car crash in Louisville, Kentucky. Finn was moved to the Annaburg Manor nursing home in Manassas, Virginia, in February 1996 so he could be near his parents and siblings, according to the Washington Post.
Although members of Finn's family vehemently opposed his wife's request, Circuit Court Judge Frank A. Hoss ruled August 31 that Hugh Finn's feeding tube could be removed. Hoss's decision was based on doctors' testimony that Finn was in a "persistent vegetative state" (PVS) and that there was "clear and convincing" evidence he would not want to remain alive in that condition, according to the Post.
Thomas Finn continues to insist that Hugh was aware of his environment and that he did not want to die. He spent five and a half hours with his son every day at Annaburg Manor, giving him a shave, brushing his teeth, and making sure he was being well cared for.
Finn told NRL News that Hugh occasionally responded to the people around him. "He would make noises when people would say the rosary," Finn recalled. "We sometimes got other responses- not every day, but sometimes."
When he told Hugh that Michele Finn was trying to have his feeding tube removed, "Hugh's face turned dark red, his mouth went up to a point, and his hands shook," Finn said. "I tried to calm him down for 45 minutes. He knew he was being put to death."
Gilmore filed an emergency appeal October 1, but both Hoss and then the state Supreme Court denied it. Gilmore's petition was based on two factors: that testimony showed that Finn may not have been in a persistent vegetative state, and that even if he was,
"he is nevertheless not dying," Gilmore said in his appeal, according to the Associated Press. "On the contrary, the manifest purpose and effect of denying him food and water is to initiate a dying process not previously present."
However, the Supreme Court ruled that Finn was in a persistent vegetative state and that under Virginia law PVS patients are considered to be terminally ill; therefore, removing their feeding tubes "merely permits the natural process of dying" and is therefore legal, the Post reported.
On November 5, 1998, less than a month after her husband's death, Michele Finn filed a lawsuit asking for compensation for her court costs and punitive sanctions against the governor and other state officials. The lawsuit described Gilmore's emergency petition to stop the feeding tube withdrawal as "ill-advised, improvident, and spurious," according to a case summary in the Supreme Court decision. Mrs. Finn claimed the governor was motivated by purely political reasons and that he had no standing to interfere in the case.
Judge Hoss, the same judge who ordered Hugh Finn's feeding tube removed, ruled on November 25, 1998, that Gilmore's suit was "not warranted by existing law" and that any challenge to the law should be "made in the political arena and not in the court, certainly not in the manner that it was done in this case." He awarded Michele Finn $13,124.20 for court costs but denied her request for punitive sanctions.
However, the unanimous state Supreme Court rejected Michele Finn's arguments and reversed Hoss's decision, ruling that the governor has a duty to intervene if he has a reasonable, good faith legal basis for suspecting that a citizen's rights may be threatened. The court found that the legal theory behind Gilmore's lawsuit was "not totally without merit," even though it was rejected by the court, and therefore the governor had a legitimate reason for filing suit and is not liable for Michele Finn's court costs.
(There is one more court case resulting from the Finn case that has not been resolved. A lawsuit is still pending over a 1999 bill passed by the Virginia state legislature awarding Michele Finn $48,000 and John Finn, Hugh Finn's brother who opposed the feeding tube removal, $10,000 for their legal costs. The money has not yet been paid due to a taxpayers' lawsuit challenging the "appropriateness" of the payments, according to the Post.)
In his statement after the ruling, Gilmore acknowledged the pain felt by Hugh Finn's family. "Hugh Finn's parents, brother, and other relatives, and even the close relatives of Michele Finn, have suffered tremendous loss and endured emotionally difficult times," Gilmore said. "I sincerely hope this ruling will help heal their wounds and help them to move on with their lives."
The Finns still believe they were right to fight for Hugh's life and they continue to grieve for their son. "I pray to God that no one else has to face this," said Joan Finn. "It was hard to have strife within the family, but we knew that if we didn't do anything we would always feel guilty."
"I will never get over it," Thomas Finn insisted. "During the night I just get up and think of Hugh. He was a part of me and my wife, but we couldn't do anything to stop his death. I would hate to see anyone else go through what we did."
Article on the subject:
http://www.ncmedicaljournal.com/jul-aug-04/ar070410.pdf
Court New York Supreme Court Appellate Division, 2d Department
Year 1987
Patient (age) Daniel Delio (33)
Nutrition + hydration Gastrostomy
Mental capacity Persistent Vegetative State (PVS)
Decision maker(s) Wife
Setting Westchester County Medical Center (Valhalla, NY)
Patient's Wishes Delio's wife testified as to her husband's vehement opposition, in several conversations, to the idea of having his life artificially maintained if he was ever in a chronic vegetative state.
Court's Decision Patients (regardless of age or medical condition) have a common law right to refuse medical treatment -- including artificial feeding -- and that they do not lose that right upon becoming incompetent so long as they meet the "clear and convincing evidence" standard (which Delio clearly did). The fact that Delio was in a PVS and not terminally ill, combined with his relative youth (34) may even make more compelling his previously expressed desire not to be sustained by artificial means "because of the potentially long and indefinite period that a young person without a terminal illness may continue to live in a vegetative condition, deriving no benefit other than mere existence from the life-sustaining treatment, but suffering the continued indignities and dehumanization created by his or her helplessness." The court also noted, with regard to its interest in preserving life: "Clearly there is no benefit to the state in preserving Daniel's existence under circumstances he would have found demeaning and degrading to his humanity and which would serve merely to lessen the value of his life by denying him the right to chose the course of his medical treatment."
Outcome Westchester County Medical Center declined to comply with the wife's wishes and arranged Delio's transfer to the palliative care unit at Beth Israel Medical Center in New York City where tube feeding was withdrawn. Delio died peacefully 9 days later.
Citation Partnership for Caring, Inc. (2001), Fact Sheet, Delio v. Westchester County Medical Center.
Case Elbaum v. Grace Plaza of Great Neck, Inc., 148 A.D. 2d 244, 544 N.Y.S.2d 840 (2d Dep't 1989)
Court New York Supreme Court Appellate Division, 2d Department
Year 1989
Patient (age) Jean Elbaum (60)
Nutrition + hydration Gastrostomy
Mental capacity Persistent Vegetative State (PVS)
Decision maker(s) usband and immediate family
Setting Grace Plaza of Great Neck (skilled nursing facility, Great Neck, NY)
Patient's Wishes Jean Elbaum made specific statements regarding not wanting to be kept alive by ventilator, antibiotics, or tubes if she were in a "vegetative like state." She referenced specific cases, such as not wanting to linger like Karen Ann Quinlan, and not wanting to die like her mother, who was tube fed when terminally ill with cancer. Elbaum extracted several promises from her husband and family members, all of whom agreed to honor her wishes. The family was united and testified to that effect.
Court's Decision The court sided with the Elbaums, saying the New York's "clear and convincing evidence" standard had been met. It ordered the nursing home to transfer Elbaum to a facility where her wishes could be honored. If no such facility could be found, it ordered the nursing home's staff to carry out the withdrawal, or, if no staff members could be found willing to comply with Elbaum's wishes, that a family designated physician be allowed into the home to do so.
Outcome Elbaum was transferred to a New York hospice where she died peacefully after tube feeding was withdrawn.
Citation Partnership for Caring, Inc. (2001), Fact Sheet: Elbaum v. Grace Plaza of Great Neck, Inc.
On March 16, 2003, the Health Care Decisions Act for Persons with Mental Retardation will become law1. This Act, which amends Surrogate Court Procedure Act §1750 by adding §1750-b, permits a guardian appointed under SCPA 17-A for a mentally retarded person to address end of life decisions for their ward. The new law addresses removal or refusal of life support including artificial nutrition or hydration (feeding tubes) and contains a very detailed section on the standards for making those serious decisions. There is no comparable section in 17-A for guardians of developmentally disabled person. The new section excludes corporate guardians (such as a nonprofit organization appointed under 17-A) from the independent authority to make end of life decisions. In New York, as in many jurisdictions, competent adults have the right to determine their own medical treatment. Competence to make health care decisions is generally the ability to make an informed, rational decision on the basis of the risks and benefits of treatment and the ability to comprehend the seriousness of a condition as well as the consequences of not having a medical procedure performed.2 Public Health Law Section Article 29-C, the Health Care Proxy Law, permits a competent adult to designate an agent for medical decision making, including end of life decisions and feeding tubes, unless he or she has been adjudicated incompetent, incapacitated 3 or a 17-A guardian has been appointed. As the result of a series of judicial decisions, if there is no health care proxy, a family member or guardian must prove by "˜clear and convincing evidence"™ that a patient or ward would forego treatment to sustain life.4
The new §1750-b sets forth the decision making standards which must be used for end of life decisions, the procedures for implementing the removal or withdrawal of life sustaining treatment, the procedures for providers to object to the decision made by a guardian, the provider"™s obligations and an immunity clause. Interestingly, the procedures in the new §1750-b are similar to Public Health Law §29-B, Orders Not to Resusictate.
It appears a feeding Tube is also "life sustaining" in Wisconsin.
Case In the Matter of Edna M.F., No. 95-2719, 1997 Wis. LEXIS 64 (Wis. June 12, 1997).
Court Wisconsin Supreme Court
Year 1997
Patient (age) Edna M.F. (71)
Nutrition + hydration Gastrostomy
Mental capacity Alzheimer's type dementia
Decision maker(s) Sister (the court appointed guardian)
Setting A long-term care facility in Wisconsin
Patient's Wishes There was no evidence that Edna M.F. had any preferences regarding treatment. The medical ethics committee at the facility where Edna M.F. resided approved the withdrawal Edna's feeding tube if no member of the family objected. The sister agreed and asked the court to issue an order approving the withdrawal. A niece was opposed to this course of action.
Court's Decision The court decided that tube feeding should continue. It argued that in the absence of advance directives or some other "clear and convincing evidence" of a patient's wishes, guardians may only approve the withdrawal of life-sustaining treatment (including artificially provided nutrition and hydration) if (1) the incompetent patient is in a Persistent Vegetative State (PVS) and (2) withdrawal of treatment can be show to be in the best interests of the incompetent patient.
Outcome After this decision was issued doctors determined that Edna M.F.'s condition had developed into a Persistent Vegetative State (PVS). Life support was withdrawn at that point and Edna M.F. died several days later. Citation Partnership for Caring, Inc. (2001), Fact Sheet, In the Matter of Edna M.
Some other cases Feeding tubes and articles
