In re Doe

45 Pa. D. & C.3d 371, 1987 Pa. Dist. & Cnty. Dec. LEXIS 237
CourtPennsylvania Court of Common Pleas, Philadelphia County
DecidedAugust 19, 1987
Docketno. 2560
StatusPublished

This text of 45 Pa. D. & C.3d 371 (In re Doe) is published on Counsel Stack Legal Research, covering Pennsylvania Court of Common Pleas, Philadelphia County primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
In re Doe, 45 Pa. D. & C.3d 371, 1987 Pa. Dist. & Cnty. Dec. LEXIS 237 (Pa. Super. Ct. 1987).

Opinion

LEHRER, J.,

This court will enter a declaratory judgment pursuant to the Declaratory Judgments Act. Pa.C.S. §§7531-7541 (Purdon, 1978).

The issue before it is justiciable. It involves balancing the common law and constitutional right to self-determination and privacy against the interest of the state in the preservation of life. All necessary and indispensable parties have been and are named of record.

The issue arose from the following operative facts: An adult, mature competent woman has been a patient iri a hospital since January 21, 1987. She suffers from Amyotrophic Lateral Sclerosis, commonly referred to as Lou Gehrig’s Disease. The disease is a continual march towards total paralysis and death.

On June 19, 1987, the patient, her family and counsel retained by patient’s family at her request, [372]*372asked her primary attending physician and the hospital to remove life sustaining support systems. The hospital and the physician, after a month of careful reflection, made it clear that while willing to accede to the patient’s wish, neither would do so without what each considered an appropriate judgment or order of the court.

On July 20, 1987, the patient filed a motion for discontinuation of a mechanical ventilator with the patient as (specifically named) petitioner and the hospital and principal attending physician as (specifically named) respondents praying the court, in effect, to order the hospital and physician to accede to her wish and to remove the ventilator.

The court, after lengthy in-chamber colloquy with counsel for these parties, entered a rule on the hospital and principal attending physician to show cause why such relief should not be granted. At the same time, the court, sua sponte, on the face of the same petition, issued a rule on the attorney general of this commonwealth to appear similarly and to show cause why the relief should not be granted.

Pursuant to the rule, testimony was taken on three different days: two in closed court and one at the patient’s hospital bedside. Extensive briefs were filed and arguments heard. On motion of the hospital concurred in by the others, the record was impounded and the court closed-its proceedings to respect the privacy of the patient and her family.

Thus, the caption of the case is styled “In re Jane Doe” and this opinion bears such caption. However, because this is a case of first impression in this commonwealth and of wide interest to the medical profession the opinion herein will not be shielded as will the record and pleadings.

Based on the testimony, pleadings, briefs and arguments of counsel, the court makes the following

[373]*373FINDINGS OF FACT

(1) Petitioner Jane Doe is a 64-year-old woman. She is afflicted with Amyotrophic Lateral Sclerosis. She is a widow; her husband died 10 years ago. She has four adult children and seven grandchildren. The children have described her and the court finds her to be a strong, independent and caring woman who tended to her home, her husband and children in better years. In the previous 10 years she has suffered several medical problems including a gastrectomy, nephrectomy and massive myocardial infarction. Although she had symptoms of ALS for several years, she was diagnosed definitively in .March 1986. Thereafter, the disease progressed rapidly.

(2) ALS is a degenerative disease which affects the function of various types of nerves,1 which leads to the progressive loss of function of body musculature except the eyes. ALS affects the movement of the arms, legs, and head, the coordination necessary to cough, to swallow and to talk. AL$ becomes a pulmonary disease as it begins to affect the vital functions of breathing. The muscles of the diaphragm and the muscles between the ribs that allow the bellows function of the chest to proceed for the intake and exhalation of air become atrophied and cease to function. In the later stages of ALS, a patient requires a nasogastric feeding tube and becomes ventilator-dependent.

(3) The prognosis is death in approximately three years from onset without life-sustaining intervention. Life is prolonged with intervention. The longest reported case of a patient afflicted with ALS [374]*374on a ventilator is 11 years.

(4) The ventilator and feeding tubes are modalities of medical treatment. They prolong the dying process. They neither arrest the underlying disease’s deterioration nor impede its process.

(5) Extensive research has been conducted into the cause of this disease: viral, allergic and environmental, yet its etiology remains unknown. There is no effective treatment, nor cure. The patient’s mental acuity and intelligence remains intact. Difficulty and frustration to the victim arises not only from increasing paralysis, but also in attempting to communicate. In a sense the patients become locked-in to his or her own mind.

(6) Some time during 1986 the patient lost the ability to speak. Next, she lost use of her legs and arms. By' October 1986, she was confined to a wheelchair. On January 15, 1987, she was treated in a hospital emergency room for shortness of breath and choking on her own secretions. Thereafter, she was admitted into the hospital on January 21, 1987. A surgical procedure was necessary to insert a nasogastric feeding tube. During this procedure, a breathing tube was inserted due to the effect of the sedation relative to her respiratory drive. The breathing tube was removed on January 23, 1987. Nevertheless, she was placed on the ventilator the next day due to an inability to breathe. She developed other complications: pneumonia, partial and total lung collapse, unstable blood pressure and irregular heart rhythm. Later, when she stabilized, an attempt was undertaken to wean her off the ventilator in increasing time intervals. This proved unsuccessful and all attempts to do so were discontinued in early April 1987. She can no longer sustain life off of the ventilator.

[375]*375(7) On February 7, 1987, she advised her physician of her wish for her full “code” status to be changed to “no:code.” She was informed and understood the ramifications thereof; to wit, that if her heart were to stop, the resuscitation team would not try to revive her, nor would antibiotics be administered if an infection set in.

(8) The patient is totally immobile except for the following: her eyes; the ability to move her head in a one-inch radius from a lateral rested position; and movement in the-right index finger with which she can “write” by forming letters on the bed sheet (by so doing, she can communicate by spelling out words). The remaining parts of her body are near total paralysis. Within 60 days she will lose the remaining use of her finger and the movement of her head. Her intelligence will remain intact. Her only means of communication will be the gleam, intelligence and voice of her eyes. Ultrasophisticated electronic systems to aid communication are available, but are of doubtful efficiency. They pick up subtle impulses from the movement of the eyeballs which activate a preprogrammed set of words. Such will be the quality of life she would endure.

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Bluebook (online)
45 Pa. D. & C.3d 371, 1987 Pa. Dist. & Cnty. Dec. LEXIS 237, Counsel Stack Legal Research, https://law.counselstack.com/opinion/in-re-doe-pactcomplphilad-1987.